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Article Dans Une Revue Blood Année : 2023

Immune effector cell–associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations

Mahmoud Aljurf
  • Fonction : Auteur
Emmanuel Bachy
Adriana Balduzzi
Pere Barba
  • Fonction : Auteur
Benedetto Bruno
Reuben Benjamin
  • Fonction : Auteur
Matteo Carrabba
Fabio Ciceri
  • Fonction : Auteur
Paolo Corradini
Julio Delgado
Roberta Di Blasi
Raffaella Greco
Gloria Iacoboni
Ulrich Jäger
Marie José Kersten
  • Fonction : Auteur
Stephan Mielke
Arnon Nagler
  • Fonction : Auteur
Francesco Onida
  • Fonction : Auteur
Zinaida Peric
  • Fonction : Auteur
Claire Roddie
Annalisa Ruggeri
  • Fonction : Auteur
Fermín Sánchez-Guijo
Isabel Sánchez-Ortega
Dominik Schneidawind
  • Fonction : Auteur
Maria-Luisa Schubert
  • Fonction : Auteur
John Snowden
Catherine Thieblemont
  • Fonction : Auteur
Max Topp
  • Fonction : Auteur
Pier Luigi Zinzani
John Gribben
Chiara Bonini
  • Fonction : Auteur
Anna Sureda
  • Fonction : Auteur

Résumé

Hematological toxicity is the most common adverse event after chimeric antigen receptor (CAR) T-cell therapy. Cytopenias can be profound and long-lasting and can predispose for severe infectious complications. In a recent worldwide survey, we demonstrated that there remains considerable heterogeneity in regard to current practice patterns. Here, we sought to build consensus on the grading and management of immune effector cell-associated hematotoxicity (ICAHT) after CAR T-cell therapy. For this purpose, a joint effort between the European Society for Blood and Marrow Transplantation (EBMT) and the European Hematology Association (EHA) involved an international panel of 36 CAR T-cell experts who met in a series of virtual conferences, culminating in a 2-day meeting in Lille, France. On the basis of these deliberations, best practice recommendations were developed. For the grading of ICAHT, a classification system based on depth and duration of neutropenia was developed for early (day 0-30) and late (after day +30) cytopenia. Detailed recommendations on risk factors, available preinfusion scoring systems (eg, CAR-HEMATOTOX score), and diagnostic workup are provided. A further section focuses on identifying hemophagocytosis in the context of severe hematotoxicity. Finally, we review current evidence and provide consensus recommendations for the management of ICAHT, including growth factor support, anti-infectious prophylaxis, transfusions, autologous hematopoietic stem cell boost, and allogeneic hematopoietic cell transplantation. In conclusion, we propose ICAHT as a novel toxicity category after immune effector cell therapy, provide a framework for its grading, review literature on risk factors, and outline expert recommendations for the diagnostic workup and short- and long-term management.
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Dates et versions

hal-04212662 , version 1 (03-10-2023)

Identifiants

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Kai Rejeski, Marion Subklewe, Mahmoud Aljurf, Emmanuel Bachy, Adriana Balduzzi, et al.. Immune effector cell–associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations. Blood, 2023, 142 (10), pp.865-877. ⟨10.1182/blood.2023020578⟩. ⟨hal-04212662⟩
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