Incidence and Management of Venous Thrombo-Embolism (VTE) Associated with CD19-Directed Chimeric Antigen Receptor (CAR) T-Cell Therapy: A Single Institution Experience
Year: 2020
Type: article
Study design: Observational Study
Abstract: Background Cancer associated venous thrombo-embolism (VTE) constitutes major cause of mortality and morbidity in patients with hematological malignancies. There is limited data on the incidence and management of VTE in patients receiving chimeric antigen receptor (CAR) T-cell therapy. Methods We performed a single center retrospective study of 148 patients receiving CD19-directed CAR T-cell therapy for aggressive B-cell lymphomas between 05/2015 and 09/2019 to evaluate the incidence and management of known and new VTE phenomenon between day 0-100 after CAR T-cell infusion. Results Prophylaxis with anticoagulation (AC) was utilized in 4% (6/148) of patients between day 0-100 after CAR T-cell infusion. 19% (28/148) had known VTE prior to CAR T-cell infusion and 50% (12/28) of these were still on AC at the time of infusion. Of those on AC for prior VTE at the time of infusion, 50% (6/12) had it held between day 0-100 after CAR T-cell infusion due to low platelet count or risk of bleeding, while the remainder continued without interruption. A new episode of VTE, between day 0-100, occurred in 11% (16/148) of patients. None of these patients had previous known VTE. Of these, 75% (12/16) started therapeutic AC, however 42% (5/12) had AC held before day 100 after CAR T-cell infusion due to low platelet count or risk of bleeding. None of the patients that continued therapeutic AC in the 2 cohorts had a bleeding event. Details of the thrombotic events and management with AC are shown in the table. Conclusions This is the first study to our knowledge that describes in detail the incidence and characteristics of VTE and use of AC in lymphoma patients receiving CAR T-cell therapy. Most patients were managed with AC without complications of recurrent VTE or bleeding.
Authors: Hamza Hashmi, Abu-Sayeef Mirza, Alicia Darwin, Constantine Logothetis, Franco Garcia, Anuhya Kommalapati, Christina A. Bachmeier, Julio C. Chavez, Bijal D. Shah, Javier Pinilla-Ibarz, Farhad Khimani, Aleksandr Lazaryan, Hien Liu, Marco L. Davila, Michael D. Jain, Frederick L. Locke, Taiga Nishihori
Institutions: Moffitt Cancer Center, University of South Florida
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W3002230105