TY - JOUR
T1 - CRP and ferritin in addition to the EASIX score predict CAR-T-related toxicity
AU - Greenbaum, Uri
AU - Strati, Paolo
AU - Saliba, Rima M.
AU - Torres, Janet
AU - Rondon, Gabriela
AU - Nieto, Yago
AU - Hosing, Chitra
AU - Srour, Samer A.
AU - Westin, Jason
AU - Fayad, Luis E.
AU - Lee, Hun J.
AU - Iyer, Swaminathan P.
AU - Nair, Ranjit
AU - Nastoupil, Loretta J.
AU - Parmar, Simrit
AU - Rodriguez, Maria A.
AU - Samaniego, Felipe
AU - Steiner, Raphael E.
AU - Wang, Michael
AU - Pinnix, Chelsea C.
AU - Flowers, Christopher R.
AU - Tummala, Sudhakar
AU - Ramdial, Jeremy L.
AU - Yalniz, Fevzi F.
AU - Hawkins, Misha
AU - Rezvani, Katayoun
AU - Champlin, Richard E.
AU - Shpall, Elizabeth J.
AU - Neelapu, Sattva S.
AU - Kebriaei, Partow
AU - Ahmed, Sairah
N1 - Publisher Copyright:
© 2021 by The American Society of Hematology.
PY - 2021/7/27
Y1 - 2021/7/27
N2 - The Endothelial Activation and Stress Index (EASIX) score, defined as [(creatinine 3 lactate dehydrogenase [LDH])/platelets], is a marker of endothelial activation that has been validated in the allogeneic hematopoietic stem cell transplant setting. Endothelial activation is one of the mechanisms driving immune-mediated toxicities in patients treated with chimeric antigen receptor-T (CAR-T)-cell therapy. This study's objective was to evaluate the association between EASIX and other laboratory parameters collected before lymphodepletion and the subsequent onset of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) those patients. Toxicity data were collected prospectively on 171 patients treated with axicabtagene ciloleucel (axi-cel) for large B-cell lymphoma (LBCL). CRS grades 2 to 4 were diagnosed in 81 (47%) patients and ICANS grades 2 to 4 in 84 (49%). EASIX combined with ferritin (EASIX-F) identified 3 risk groups with CRS grades 2 to 4 cumulative incidence of 74% (hazards ratio [HR], 4.8; 95% confidence interval [CI], 2.1-11; P < .001), 49% (HR, 2.3; 95% CI, 1.02-5; P 5 .04), and 23% (reference), respectively. EASIX combined with CRP and ferritin (EASIX-FC) identified 3 risk groups with an ICANS grade 2 to 4 cumulative incidence of 74% (HR, 3.6; 95% CI, 1.9-6.9; P < .001), 51% (HR, 2.1; 95% CI, 1.1-3.9; P 5 .025), and 29% (reference). Our results indicate that common laboratory parameters before lymphodepletion correlate with CAR-T-related toxicities and can help support clinical decisions, such as preemptive toxicity management, hospitalization length, and proper setting for CAR-T administration.
AB - The Endothelial Activation and Stress Index (EASIX) score, defined as [(creatinine 3 lactate dehydrogenase [LDH])/platelets], is a marker of endothelial activation that has been validated in the allogeneic hematopoietic stem cell transplant setting. Endothelial activation is one of the mechanisms driving immune-mediated toxicities in patients treated with chimeric antigen receptor-T (CAR-T)-cell therapy. This study's objective was to evaluate the association between EASIX and other laboratory parameters collected before lymphodepletion and the subsequent onset of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) those patients. Toxicity data were collected prospectively on 171 patients treated with axicabtagene ciloleucel (axi-cel) for large B-cell lymphoma (LBCL). CRS grades 2 to 4 were diagnosed in 81 (47%) patients and ICANS grades 2 to 4 in 84 (49%). EASIX combined with ferritin (EASIX-F) identified 3 risk groups with CRS grades 2 to 4 cumulative incidence of 74% (hazards ratio [HR], 4.8; 95% confidence interval [CI], 2.1-11; P < .001), 49% (HR, 2.3; 95% CI, 1.02-5; P 5 .04), and 23% (reference), respectively. EASIX combined with CRP and ferritin (EASIX-FC) identified 3 risk groups with an ICANS grade 2 to 4 cumulative incidence of 74% (HR, 3.6; 95% CI, 1.9-6.9; P < .001), 51% (HR, 2.1; 95% CI, 1.1-3.9; P 5 .025), and 29% (reference). Our results indicate that common laboratory parameters before lymphodepletion correlate with CAR-T-related toxicities and can help support clinical decisions, such as preemptive toxicity management, hospitalization length, and proper setting for CAR-T administration.
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U2 - 10.1182/bloodadvances.2021004575
DO - 10.1182/bloodadvances.2021004575
M3 - Article
C2 - 34264268
AN - SCOPUS:85111191843
SN - 2473-9529
VL - 5
SP - 2799
EP - 2806
JO - Blood Advances
JF - Blood Advances
IS - 14
ER -