Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy
IntroductionHematologic toxicity (HT) is a joint adverse event after CAR-T cells infusion. Some patients experience prolonged hematologic toxicity (PHT), which is challenging to treat.MethodsWe collected clinical data from patients with relapsed refractory B-ALL treated with CD19 CAR-T cells. Patien...
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1139559/full |
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| author | Jiaxi Wang Meng Zhang Hairong Lyu Ruiting Guo Xia Xiao Xue Bai Yedi Pu Juanxia Meng Qing Li Ting Yuan Wenyi Lu Mingfeng Zhao |
| author_facet | Jiaxi Wang Meng Zhang Hairong Lyu Ruiting Guo Xia Xiao Xue Bai Yedi Pu Juanxia Meng Qing Li Ting Yuan Wenyi Lu Mingfeng Zhao |
| author_sort | Jiaxi Wang |
| collection | DOAJ |
| description | IntroductionHematologic toxicity (HT) is a joint adverse event after CAR-T cells infusion. Some patients experience prolonged hematologic toxicity (PHT), which is challenging to treat.MethodsWe collected clinical data from patients with relapsed refractory B-ALL treated with CD19 CAR-T cells. Patients with PHT who did not respond to erythropoietin, platelet receptor agonists, transfusion, or G-CSF and eventually received low-dose prednisone therapy were included in the analysis. We retrospectively analyzed the efficacy and safety of low-dose prednisone on PHT.ResultsAmong 109 patients treated with CD19 CAR-T cells, 78.9% (86/109) of patients were evaluated as PHT. Of these, 15 patients had persistent hematological toxicity after infusion (12 were grade 3/4 cytopenia, 12 were trilineage cytopenia and 3 were bilineage cytopenia), 2 developed cytopenia without apparent cause after D28. The initial prednisone dose was 0.5 mg/kg/day, and the median response time was 21 days (7-40 days). The recovery rate of blood count was 100%, and the complete recovery rate ranged from 60% to 66.67%. Especially exciting was that HT recurred in 6 patients after stopping prednisone. They were relieved again after the administration of prednisone. The median follow-up time was 14.97 months (4.1-31.2 months). Twelve-month duration of PFS and OS rates were 58.8% (±11.9%) and 64.7% (±11.6%). We did not observe any other side effects of prednisone apart from drug-controllable hyperglycemia and hypertension.DiscussionWe suggest that low-dose prednisone is a beneficial and tolerable therapy for PHT after CAR-T cells. The trials have been registered at www.chictr.org.cn as ChiCTR-ONN-16009862 (November 14, 2016) and ChiCTR1800015164 (March 11, 2018). |
| first_indexed | 2024-04-10T00:43:18Z |
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| id | doaj.art-cc52c3e7650f435f94c46230772cda24 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-10T00:43:18Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj.art-cc52c3e7650f435f94c46230772cda242023-03-14T05:00:39ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-03-011410.3389/fimmu.2023.11395591139559Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapyJiaxi WangMeng ZhangHairong LyuRuiting GuoXia XiaoXue BaiYedi PuJuanxia MengQing LiTing YuanWenyi LuMingfeng ZhaoIntroductionHematologic toxicity (HT) is a joint adverse event after CAR-T cells infusion. Some patients experience prolonged hematologic toxicity (PHT), which is challenging to treat.MethodsWe collected clinical data from patients with relapsed refractory B-ALL treated with CD19 CAR-T cells. Patients with PHT who did not respond to erythropoietin, platelet receptor agonists, transfusion, or G-CSF and eventually received low-dose prednisone therapy were included in the analysis. We retrospectively analyzed the efficacy and safety of low-dose prednisone on PHT.ResultsAmong 109 patients treated with CD19 CAR-T cells, 78.9% (86/109) of patients were evaluated as PHT. Of these, 15 patients had persistent hematological toxicity after infusion (12 were grade 3/4 cytopenia, 12 were trilineage cytopenia and 3 were bilineage cytopenia), 2 developed cytopenia without apparent cause after D28. The initial prednisone dose was 0.5 mg/kg/day, and the median response time was 21 days (7-40 days). The recovery rate of blood count was 100%, and the complete recovery rate ranged from 60% to 66.67%. Especially exciting was that HT recurred in 6 patients after stopping prednisone. They were relieved again after the administration of prednisone. The median follow-up time was 14.97 months (4.1-31.2 months). Twelve-month duration of PFS and OS rates were 58.8% (±11.9%) and 64.7% (±11.6%). We did not observe any other side effects of prednisone apart from drug-controllable hyperglycemia and hypertension.DiscussionWe suggest that low-dose prednisone is a beneficial and tolerable therapy for PHT after CAR-T cells. The trials have been registered at www.chictr.org.cn as ChiCTR-ONN-16009862 (November 14, 2016) and ChiCTR1800015164 (March 11, 2018).https://www.frontiersin.org/articles/10.3389/fimmu.2023.1139559/fullCAR-T cellsacute lymphocytic leukemiaprolonged hematologic toxicityprednisonehematopoietic recovery |
| spellingShingle | Jiaxi Wang Meng Zhang Hairong Lyu Ruiting Guo Xia Xiao Xue Bai Yedi Pu Juanxia Meng Qing Li Ting Yuan Wenyi Lu Mingfeng Zhao Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy Frontiers in Immunology CAR-T cells acute lymphocytic leukemia prolonged hematologic toxicity prednisone hematopoietic recovery |
| title | Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy |
| title_full | Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy |
| title_fullStr | Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy |
| title_full_unstemmed | Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy |
| title_short | Low-dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post-CD19 CAR-T cell therapy |
| title_sort | low dose administration of prednisone has a good effect on the treatment of prolonged hematologic toxicity post cd19 car t cell therapy |
| topic | CAR-T cells acute lymphocytic leukemia prolonged hematologic toxicity prednisone hematopoietic recovery |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1139559/full |
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