Cytokine release syndrome (CRS) and consumptive coagulopathy can complicate the treatment with chimeric antigen receptor T (CAR-T) cells. The modified version of the Endothelial Activation and Stress Index (mEASIX), a score derived from haematopoietic stem cell transplantation, combines platelets, C-reactive protein (CRP), and lactate dehydrogenase (LDH) and has been correlated with CRS and endothelial biomarkers. In 38 consecutive patients with aggressive lymphoproliferative disease we measured a coagulative laboratory panel at baseline and early after infusion of anti-CD19 CAR-T. The panel was investigated also in the presence of CRS graded 2 or higher, or immune effector cell-associated neurotoxicity syndrome (ICANS). Moreover, we examined the relationship between mEASIX, coagulation biomarkers, and toxicities of CAR-T cells. During CRS grade 2 or higher, we found increased prothrombin time (PT) and activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, factor VIII (FVIII), and von Willebrand factor (vWF) antigen levels, and decreased platelet count and antithrombin levels. The occurrence of immune effector cell-associated neurotoxicity syndrome was associated with higher PT values, D-dimer, FVIII, and vWF levels, and decreased fibrinogen levels and platelet count. A higher mEASIX score correlated with increased aPTT values, fibrinogen, D-dimer, FVIII and vWF levels, and decreased antithrombin levels. Baseline mEASIX was predictive for consumptive coagulopathy and CRS graded 2 or higher, and for progression-free survival and overall survival.

1 2, E. G., Sora', F., 1 2, S. H., 1 2, A. F., Ilaria Pansini, 1., Francesco Autore, 2., Elisabetta Metafuni, 2., Idanna Innocenti, 2., Maria Assunta Limongiello, 2., Sabrina Giammarco, 2., 1 2, L. L., 1 2, A. B., 1 2, P. C., 1 2, V. D. S., 1 2, S. S., Endothelial activation predicts disseminated intravascular coagulopathy, cytokine release syndrome and prognosis in patients treated with anti-CD19 CAR-T cells, <<BRITISH JOURNAL OF HAEMATOLOGY>>, 2022; Br J Haematol . 2022 Dec 11. (Br J Haematol . 2022 Dec 11.): doi: 10.1111/bjh.18596. Online ahead of print.-doi: 10.1111/bjh.18596. Online ahead of print. [https://hdl.handle.net/10807/222505]

Endothelial activation predicts disseminated intravascular coagulopathy, cytokine release syndrome and prognosis in patients treated with anti-CD19 CAR-T cells

Sora', Federica
Primo
Data Curation
;
2022

Abstract

Cytokine release syndrome (CRS) and consumptive coagulopathy can complicate the treatment with chimeric antigen receptor T (CAR-T) cells. The modified version of the Endothelial Activation and Stress Index (mEASIX), a score derived from haematopoietic stem cell transplantation, combines platelets, C-reactive protein (CRP), and lactate dehydrogenase (LDH) and has been correlated with CRS and endothelial biomarkers. In 38 consecutive patients with aggressive lymphoproliferative disease we measured a coagulative laboratory panel at baseline and early after infusion of anti-CD19 CAR-T. The panel was investigated also in the presence of CRS graded 2 or higher, or immune effector cell-associated neurotoxicity syndrome (ICANS). Moreover, we examined the relationship between mEASIX, coagulation biomarkers, and toxicities of CAR-T cells. During CRS grade 2 or higher, we found increased prothrombin time (PT) and activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, factor VIII (FVIII), and von Willebrand factor (vWF) antigen levels, and decreased platelet count and antithrombin levels. The occurrence of immune effector cell-associated neurotoxicity syndrome was associated with higher PT values, D-dimer, FVIII, and vWF levels, and decreased fibrinogen levels and platelet count. A higher mEASIX score correlated with increased aPTT values, fibrinogen, D-dimer, FVIII and vWF levels, and decreased antithrombin levels. Baseline mEASIX was predictive for consumptive coagulopathy and CRS graded 2 or higher, and for progression-free survival and overall survival.
Inglese
1 2, E. G., Sora', F., 1 2, S. H., 1 2, A. F., Ilaria Pansini, 1., Francesco Autore, 2., Elisabetta Metafuni, 2., Idanna Innocenti, 2., Maria Assunta Limongiello, 2., Sabrina Giammarco, 2., 1 2, L. L., 1 2, A. B., 1 2, P. C., 1 2, V. D. S., 1 2, S. S., Endothelial activation predicts disseminated intravascular coagulopathy, cytokine release syndrome and prognosis in patients treated with anti-CD19 CAR-T cells, <<BRITISH JOURNAL OF HAEMATOLOGY>>, 2022; Br J Haematol . 2022 Dec 11. (Br J Haematol . 2022 Dec 11.): doi: 10.1111/bjh.18596. Online ahead of print.-doi: 10.1111/bjh.18596. Online ahead of print. [https://hdl.handle.net/10807/222505]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/222505
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