CAR-HEMATOTOX

  • The CAR-HEMATOTOX risk-stratifies for hematological toxicity in patients receiving CD19-directed CAR T-cell therapy for large B-cell lymphoma (LBCL). The score is determined prior to lymphodepleting chemotherapy (e.g. day 5) and separates patients in to a high vs. low-risk group.
  • Due to the test characteristics (high sensitivity, lower specificity), the score has a high negative predictive value, and thus is particularly helpful in ruling out patients at risk for severe hematotoxicity.
  • Because of the lower positive predictive value, not all high-risk patients will develop severe hematotoxicity (expect false positives).
  • The score is simple to use, provides clear cutoffs, and was validated in two large independent international cohorts.
  • The score may be useful to guide anti-infective prophylaxis and growth factor support in a real-world clinical setting.

Background

Hematological toxicity represents a frequent adverse event after chimeric antigen receptor (CAR) T-cell therapy, and can predispose for severe infectious complications. Determined prior to lymphodepleting chemotherapy (e.g. day -5), the CAR-HEMATOTOX score comprises five markers of hematotoxicity with additional weighting of the baseline platelet count and ferritin levels. The score discriminates between a high (CAR-HEMATOTOX score ≥2) and low (CAR-HEMATOTOX score 0-1) risk for hematotoxicity.

Please note that this score was established and validated only in patients with large B-cell lymphoma receiving Axicabtagene ciloleucel or Tisagenlecleucel in a real-world setting. The model was validated in two independent patient cohorts and discriminated patients with severe neutropenia ≥14 days vs. <14 days (pooled validation: AUC 0.89, sensitivity 89%, specificity 68%).

For details see CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed/refractory large B-cell lymphoma. Rejeski et al. Blood (2021) 138 (24): 2499-2513.

In a multi-center follow-up study, the score further identified patients at risk for severe infections and disease progression: The CAR-HEMATOTOX risk-stratifies patients for severe infections and disease progression after CD19 CAR-T for R/R LBCL. Rejeski et al. J Immunother Cancer (2022) May; 10 (5): e004475.

Calculator

Here you can calculate the CAR-HEMATOTOX score and the resulting risk group (high versus low). By using this calculator, you accept that the GLA does not assume any liability.

 

 
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