An International Survey on Grading, ...
Document type :
Article dans une revue scientifique: Article original
PMID :
Permalink :
Title :
An International Survey on Grading, Diagnosis, and Management of Immune Effector Cell-Associated Hematotoxicity (ICAHT) Following CAR T-cell Therapy on Behalf of the EBMT and EHA.
Author(s) :
Rejeski, Kai [Auteur]
Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München [LMU]
Greco, Raffaella [Auteur]
San Raffaele Scientific Institute
Onida, Francesco [Auteur]
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Sánchez-Ortega, Isabel [Auteur]
Bonini, Chiara [Auteur]
IRCCS San Raffaele Scientific Institute [Milan, Italie]
Sureda, Anna [Auteur]
Universitat de Barcelona [UB]
Gribben, John G. [Auteur]
Queen Mary University of London [QMUL]
Yakoub-Agha, Ibrahim [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Subklewe, Marion [Auteur]
Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München [LMU]
Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München [LMU]
Greco, Raffaella [Auteur]
San Raffaele Scientific Institute
Onida, Francesco [Auteur]
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Sánchez-Ortega, Isabel [Auteur]
Bonini, Chiara [Auteur]
IRCCS San Raffaele Scientific Institute [Milan, Italie]
Sureda, Anna [Auteur]
Universitat de Barcelona [UB]
Gribben, John G. [Auteur]
Queen Mary University of London [QMUL]
Yakoub-Agha, Ibrahim [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Subklewe, Marion [Auteur]
Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München [LMU]
Journal title :
HemaSphere
Abbreviated title :
HEMASPHERE
Volume number :
7
Pages :
e889
Publication date :
2023-05-02
ISSN :
2572-9241
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Hematological toxicity represents the most common grade ≥3 toxicity after chimeric antigen receptor (CAR) T-cell therapy. However, its underlying pathophysiology is incompletely understood and its grading and management ...
Show more >Hematological toxicity represents the most common grade ≥3 toxicity after chimeric antigen receptor (CAR) T-cell therapy. However, its underlying pathophysiology is incompletely understood and its grading and management remains ill-defined. To inform the forthcoming European Hematology Association/European Society for Blood and Marrow Transplantation (EHA/EBMT) guidelines on the management of “immune effector cell-associated hematotoxicity” (ICAHT), we undertook a survey of experienced clinicians using an online survey focusing on (1) grading, (2) risk-stratification and diagnostic work-up, (3) short-term, and (4) long-term management of ICAHT. There were 81 survey respondents across 18 countries. A high degree of variability was noted for cytopenia grading in regards to depth, duration, and time from CAR-T infusion. The majority of experts favored pre-CAR-T bone marrow studies, especially in case of a high-risk profile. Most respondents felt that the work-up for patients with severe hematotoxicity should rule-out viral infections (96%), substrate deficiency (80%), or coincident sHLH/MAS (serum ferritin, 92%), and should include bone marrow aspiration (86%) and/or biopsy (61%). Clinicians were divided as to whether the occurrence of coincident immunotoxicity should influence the decision to apply G-CSF, and when to initiate G-CSF support. In case of prolonged thrombocytopenia, most survey participants favored thrombopoietin agonists (86%). Conversely, autologous hematopoietic cell boosts represented the preferred choice for neutropenia (63%), although they were frequently not available and no consensus was reached regarding the optimal trigger point. These findings underline the current heterogeneity of practice patterns regarding ICAHT and invite the development of consensus guidelines, which may harmonize grading, establish standard operating procedures for diagnosis, and set management guidelines.Show less >
Show more >Hematological toxicity represents the most common grade ≥3 toxicity after chimeric antigen receptor (CAR) T-cell therapy. However, its underlying pathophysiology is incompletely understood and its grading and management remains ill-defined. To inform the forthcoming European Hematology Association/European Society for Blood and Marrow Transplantation (EHA/EBMT) guidelines on the management of “immune effector cell-associated hematotoxicity” (ICAHT), we undertook a survey of experienced clinicians using an online survey focusing on (1) grading, (2) risk-stratification and diagnostic work-up, (3) short-term, and (4) long-term management of ICAHT. There were 81 survey respondents across 18 countries. A high degree of variability was noted for cytopenia grading in regards to depth, duration, and time from CAR-T infusion. The majority of experts favored pre-CAR-T bone marrow studies, especially in case of a high-risk profile. Most respondents felt that the work-up for patients with severe hematotoxicity should rule-out viral infections (96%), substrate deficiency (80%), or coincident sHLH/MAS (serum ferritin, 92%), and should include bone marrow aspiration (86%) and/or biopsy (61%). Clinicians were divided as to whether the occurrence of coincident immunotoxicity should influence the decision to apply G-CSF, and when to initiate G-CSF support. In case of prolonged thrombocytopenia, most survey participants favored thrombopoietin agonists (86%). Conversely, autologous hematopoietic cell boosts represented the preferred choice for neutropenia (63%), although they were frequently not available and no consensus was reached regarding the optimal trigger point. These findings underline the current heterogeneity of practice patterns regarding ICAHT and invite the development of consensus guidelines, which may harmonize grading, establish standard operating procedures for diagnosis, and set management guidelines.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Université de Lille
Inserm
CHU Lille
Inserm
CHU Lille
Submission date :
2024-01-11T22:52:40Z
2024-03-22T14:52:59Z
2024-03-22T14:52:59Z