Haemophagocytic lymphohistiocytosis (HLH) in patients with large B-cell lymphoma treated with standard of care (SOC) axicabtagene ciloleucel (Axi-cel).

医学 内科学 噬血细胞性淋巴组织细胞增多症 噬血作用 背景(考古学) 胃肠病学 托珠单抗 细胞因子释放综合征 骨髓 肿瘤科 外科 癌症 嵌合抗原受体 免疫疗法 疾病 古生物学 生物 全血细胞减少症
作者
Sairah Ahmed,Fateeha Furqan,Paolo Strati,Jason R. Westin,Luis Fayad,Frederick Hagemeister,Hun Ju Lee,Swaminathan P. Iyer,Ranjit Nair,Loretta J. Nastoupil,Simrit Parmar,Maria Alma Rodriguez,Felipe Samaniego,Raphaël Steiner,Michael Wang,Chelsea C. Pinnix,Christopher R. Flowers,Sandra B. Horowitz,Misha Hawkins,Sattva S. Neelapu
出处
期刊:Journal of Clinical Oncology [American Society of Clinical Oncology]
卷期号:38 (15_suppl): 8057-8057 被引量:15
标识
DOI:10.1200/jco.2020.38.15_suppl.8057
摘要

8057 Background: HLH is a rare but serious complication of chimeric antigen receptor (CAR) T cell therapy, characterized by severe immune activation, and immune mediated multi-organ failure. Diagnosis is difficult in the context of cytokine release syndrome (CRS) and optimal treatment and outcomes are unclear. Methods: Retrospective, descriptive analysis of patients with relapsed/refractory LBCL treated with SOC axi-cel at MD Anderson Cancer Center between 01/2018 - 10/2019 (data cut-off 12/21/2019). Progression-free survival (PFS) defined as time from axi-cel infusion to progression/death or last follow-up. Diagnosis of HLH per HLH-2004 and CART cell therapy toxicity guidelines (Neelapu, 2018) Results: One hundred and five patients with relapsed/refractory LBCL included, 6 diagnosed with HLH. No significant difference in baseline characteristics, disease stage, international prognostic index or inflammatory markers at baseline between groups, with exception of platelet count which was lower in HLH group 116 [37-129] versus 141 [9-391] (p = 0.07). Development of HLH was early after CART cell infusion at a median 11 days [7 – 78 days] with 3 patients having bone marrow hemophagocytosis; all 6 had abnormalities in liver function tests, fibrinogen, triglycerides, and at least 1 ferritin level > 10,000. CART toxicity in HLH cohort: 4 patients experienced grade 0-1 CRS, and 1 with grade 2 CRS while 3 HLH patients experienced grade 3-4 IEC-associated neurotoxicity syndrome ( ICANS), and 2 patients had grade 0-1 ICANS. Five HLH patients treated with high dose steroids, and tocilizumab; anakinra administered in 2 patients. Four of 6 patients had resolution of HLH with treatment and didn’t require escalation to HLH specific therapy however 1 patient was treated with steroids/etoposide. PFS and overall survival (OS) were significantly shorter in HLH group, PFS 1 months vs 8 months, respectively (p < 0.001) and median OS 2 months vs not reached, respectively (p = 0.001) follow up 10 months (95% CI 8-12 months). One patient died of acute respiratory failure, 2 patients died of HLH and multi-organ failure without progressive disease (PD). Of 3 remaining patients, all had radiographic PD at day 30, 2 of whom died of PD. Conclusions: HLH is likely an underreported complication of CART cell therapy, and patients with HLH have significantly worse outcomes. In this series the majority of patients died of PD, not the syndrome itself. More information is necessary to design treatment strategies that won’t compromise CART outcomes.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
上邪完成签到 ,获得积分10
1秒前
babyuer完成签到,获得积分10
1秒前
万能图书馆应助CIXI采纳,获得10
1秒前
2秒前
gslscuer完成签到,获得积分10
2秒前
3秒前
假面绅士发布了新的文献求助10
3秒前
4秒前
4秒前
冰西瓜完成签到 ,获得积分10
4秒前
曼夭非夭完成签到,获得积分10
5秒前
kyslcg完成签到,获得积分20
5秒前
6秒前
splaker7完成签到,获得积分10
6秒前
jianmin发布了新的文献求助10
7秒前
酷波er应助尊敬湘采纳,获得10
7秒前
二丫完成签到,获得积分10
7秒前
派大珊发布了新的文献求助10
8秒前
大船发布了新的文献求助10
9秒前
10秒前
sansan完成签到,获得积分10
11秒前
万能图书馆应助Michaelialzm采纳,获得10
11秒前
假面绅士发布了新的文献求助10
11秒前
Yunnnnn_完成签到,获得积分10
11秒前
12秒前
朴实初夏完成签到 ,获得积分10
12秒前
小叶发布了新的文献求助10
12秒前
13秒前
科研小白发布了新的文献求助10
14秒前
竹前家庆完成签到,获得积分10
15秒前
你好发布了新的文献求助10
16秒前
CIXI发布了新的文献求助10
16秒前
微风打了烊完成签到 ,获得积分10
17秒前
假面绅士发布了新的文献求助10
18秒前
SCI的芷蝶完成签到 ,获得积分10
18秒前
千秋骚年关注了科研通微信公众号
19秒前
19秒前
20秒前
20秒前
高分求助中
The ACS Guide to Scholarly Communication 2500
Sustainability in Tides Chemistry 2000
Studien zur Ideengeschichte der Gesetzgebung 1000
TM 5-855-1(Fundamentals of protective design for conventional weapons) 1000
Threaded Harmony: A Sustainable Approach to Fashion 810
Pharmacogenomics: Applications to Patient Care, Third Edition 800
Genera Insectorum: Mantodea, Fam. Mantidæ, Subfam. Hymenopodinæ (Classic Reprint) 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3082743
求助须知:如何正确求助?哪些是违规求助? 2736027
关于积分的说明 7539806
捐赠科研通 2385554
什么是DOI,文献DOI怎么找? 1264970
科研通“疑难数据库(出版商)”最低求助积分说明 612857
版权声明 597685