Patients with relapsed or refractory mantle cell lymphoma (MCL) and a high CAR-hematotox score had an increased risk for hematologic toxicity, infections, and an inferior progression-free survival and overall survival following treatment with brexucabtagene autoleucel (brexu-cel).

“The CAR-hematotox score predicts the risk for prolonged neutropenia, severe infections, and poor treatment outcomes after CD19 CAR T-cell therapy,” said Dr. Kai Rejeski (LMU Munich, Germany) at the start of his presentation at the 2022 annual meeting of the American Society of Hematology.1,2 The use of this tool in patients with relapsed/refractory MCL undergoing CD19 CAR T-cell therapy has not yet been established. Therefore, the current international, multicenter, retrospective study analyzed the applicability of the CAR-hematotox score in 103 patients with relapsed/refractory MCL receiving brexu-cel.

At baseline, high CAR-hematotox scores (HT-high) were related to aggressive disease biology, increased bone marrow infiltration, a higher number of prior treatments, and increased disease activity. Patients with HT-high had higher risk for hematologic toxicity than patients with HT-low: neutropenia (median 14 days vs 6 days; P<0.001); aplastic phenotype (47% vs 0%; P<0.001). Anemia and profound or prolonged cytopenia were also more frequently observed in HT-high patients. Furthermore, severe infections were more common in HT-high patients than in HT-low patients (30% vs 5%; P=0.001), mostly driven by an increase in bacterial infections (28% vs 5%; P=0.002). After 720 days of follow-up, HT-high scores were associated with poorer progression-free survival (38% vs 79%; P<0.0001) and overall survival (52% vs 90%; P=0.00016) than HT-low scores.

According to Dr. Rejeski and colleagues, stratifying patients for the risk of hematologic toxicity may aid physicians to tailor the management of their patients.

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