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KyoTox-e score; prediction of post-CAR-T prolonged thrombocytopenia using peripheral blood data before apheresis

Bone Marrow Transplantation volume 59, pages 419–421 (2024)Cite this article

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Even though chimeric antigen receptor T (CAR-T) cell therapy targeting CD19 has improved prognosis for relapsed or refractory (r/r) B-cell lymphomas [1,2,3,4], a unique toxicity profile remains a barrier in clinical practice [5,6,7]. In particular, prolonged hematotoxicity has become one of the most common late-onset complications. A previous study proposed a score, CAR-HEMATOTOX, that predicts prolonged hematotoxicity using hemoglobin, platelet counts, neutrophil counts, C-reactive protein (CRP), and ferritin levels just before lymphodepletion (LD) chemotherapy [8]. As variables just before LD chemotherapy are influenced by bridging therapies and cannot be utilized until right before CAR-T cell infusion, predictive factors available well in advance can further improve operation of CAR-T cell therapy. Here, we focused on laboratory data at the time of apheresis and analyzed its association with prolonged thrombocytopenia.

We conducted a retrospective study, enrolling all consecutive patients with r/r B-cell lymphomas who received tisagenlecleucel, lisocabtagene maraleucel, or axicabtagene ciloleucel at Kyoto University Hospital between December 2019 and February 2023. Patients who received chemotherapy within 60 days after infusion, and patients without consecutive laboratory data until 60 days after infusion were excluded from the analysis. Our Institutional Review Board approved the study. Written informed consent was obtained from all patients.

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Fig. 1: KyoTox-e scores identified patients with prolonged thrombocytopenia after CAR-T cell therapy.

Data availability

Analyzed data will be shared via emails to the corresponding author.

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Acknowledgements

We are grateful to clinical engineers, nurses, transplant coordinators, and all clinicians at Kyoto University Hospital for their support, as well as patients who contributed to this research. This work was supported, in part, by the Program for Development of Next-generation Leading Scientists with Global Insight (L-INSIGHT), sponsored by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan to YA.

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Authors and Affiliations

  1. Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan

    Tomoyasu Jo, Yasuyuki Arai, Miki Nagao & Akifumi Takaori-Kondo

  2. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tomoyasu Jo, Yasuyuki Arai, Toshio Kitawaki, Naokazu Nakamura, Momoko Nishikori, Chisaki Mizumoto, Junya Kanda, Kouhei Yamashita & Akifumi Takaori-Kondo

  3. Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Tomoyasu Jo, Yasuyuki Arai & Miki Nagao

  4. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Momoko Nishikori

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  1. Tomoyasu Jo
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  2. Yasuyuki Arai
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  10. Akifumi Takaori-Kondo
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Contributions

TJ and YA designed the study, reviewed, and analyzed data. TJ and YA wrote the paper; TK, NN, M. Nishikori, CM, JK, KY, M. Nagao, and AT-K interpreted the data and revised the manuscript. All authors critiqued the manuscript.

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Correspondence to Yasuyuki Arai.

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Jo, T., Arai, Y., Kitawaki, T. et al. KyoTox-e score; prediction of post-CAR-T prolonged thrombocytopenia using peripheral blood data before apheresis. Bone Marrow Transplant 59, 419–421 (2024). https://doi.org/10.1038/s41409-023-02175-1

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