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<p>The CAR-HEMATOTOX (CAR-HT) score can assess hematotoxicity risk, but its utility in guiding supportive care remains underexplored. We analyzed 224 multiple myeloma patients treated with BCMA-directed CAR-T therapy (2016–2024), stratified by CAR-HT score (low &lt;2 vs high ≥2). We evaluated the incidence and timing of early immune effector cell-associated hematotoxicity (ICAHT), other cytopenias, transfusion burden, cytopenia-directed interventions (growth factors and stem cell boosts), infections, and survival outcomes. High CAR-HT scores (58%) were associated with more grade 3 ICAHT (45.4% vs 23.3%) and grade 4 ICAHT (5.4% vs 1.2%; <i>p</i> = 0.0069), higher rates of grade ≥3 anemia (43.1% vs 24.4%, <i>p</i> &lt; 0.0001) and thrombocytopenia (50.8% vs 27.9%, <i>p</i> &lt; 0.0001). These patients were 7 times more likely to require red cell and platelet transfusions (<i>p</i> &lt; 0.0001). G-CSF and TPO agonists were variably effective. Stem cell boosts (4%) led to rapid trilineage recovery. Infections occurred more frequently among high CAR-HT patients and those receiving intensive cytopenia-directed interventions. There were no significant differences in progression-free or overall survival between CAR-HT groups. Cytopenia-directed interventions did not affect survival. The CAR-HT score is a practical clinical risk tool that predicts transfusion burden and helps guide supportive care after BCMA CAR-T therapy.</p>

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Management of hematological toxicities after BCMA-directed CAR-T cell therapy

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月30日

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  • Joselle Cook,
  • Supriya Gupta,
  • Nadine Abdallah,
  • Matthew Rees,
  • Christopher Graham,
  • Lay She Ng,
  • Radhika Bansal,
  • Andre De Menezes Silva Corraes,
  • Kristina Helms,
  • Rahma Warsame,
  • David Dingli,
  • Wilson Gonsalves,
  • Taxiarchis Kourelis,
  • Morie Gertz,
  • Suzanne Hayman,
  • Nelson Leung,
  • Prashant Kapoor,
  • Lisa Hwa,
  • Amie Fonder,
  • Miriam Hobbs,
  • Leif Bergsagel,
  • Udit Yadav,
  • Erin Wiedmeier-Nutor,
  • Saurabh Chhabra,
  • Rafael Fonseca,
  • Sikander Ailawadhi,
  • Ricardo Parrondo,
  • Shaji Kumar,
  • Yi Lin

摘要

The CAR-HEMATOTOX (CAR-HT) score can assess hematotoxicity risk, but its utility in guiding supportive care remains underexplored. We analyzed 224 multiple myeloma patients treated with BCMA-directed CAR-T therapy (2016–2024), stratified by CAR-HT score (low <2 vs high ≥2). We evaluated the incidence and timing of early immune effector cell-associated hematotoxicity (ICAHT), other cytopenias, transfusion burden, cytopenia-directed interventions (growth factors and stem cell boosts), infections, and survival outcomes. High CAR-HT scores (58%) were associated with more grade 3 ICAHT (45.4% vs 23.3%) and grade 4 ICAHT (5.4% vs 1.2%; p = 0.0069), higher rates of grade ≥3 anemia (43.1% vs 24.4%, p < 0.0001) and thrombocytopenia (50.8% vs 27.9%, p < 0.0001). These patients were 7 times more likely to require red cell and platelet transfusions (p < 0.0001). G-CSF and TPO agonists were variably effective. Stem cell boosts (4%) led to rapid trilineage recovery. Infections occurred more frequently among high CAR-HT patients and those receiving intensive cytopenia-directed interventions. There were no significant differences in progression-free or overall survival between CAR-HT groups. Cytopenia-directed interventions did not affect survival. The CAR-HT score is a practical clinical risk tool that predicts transfusion burden and helps guide supportive care after BCMA CAR-T therapy.