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  • Safety of allogeneic hemato...
    Shadman, Mazyar; Gauthier, Jordan; Hay, Kevin A.; Voutsinas, Jenna M.; Milano, Filippo; Li, Ang; Hirayama, Alexandre V.; Sorror, Mohamed L.; Cherian, Sindhu; Chen, Xueyan; Cassaday, Ryan D.; Till, Brian G.; Gopal, Ajay K.; Sandmaier, Brenda M.; Maloney, David G.; Turtle, Cameron J.

    Blood advances, 10/2019, Letnik: 3, Številka: 20
    Journal Article

    Allogeneic hematopoietic cell transplantation (allo-HCT) is offered to selected patients after chimeric antigen receptor–modified T-cell (CAR-T) therapy. Lymphodepleting chemotherapy and CAR-T therapy have immunosuppressive and immunomodulatory effects that could alter the safety profile of subsequent allo-HCT. We reviewed our experience with 32 adults (acute lymphoblastic leukemia ALL, n = 19; B-cell non-Hodgkin lymphoma NHL/chronic lymphocytic leukemia CLL, n = 13) who received an allo-HCT after CAR-T therapy, with a focus on posttransplant toxicities. Myeloablative conditioning (MAC) was used in 74% of ALL patients and 39% of NHL/CLL patients. The median time from CAR-T therapy to allo-HCT was 72 days in ALL patients and 122 days in NHL/CLL patients. Cumulative incidences of grade 3-4 acute graft-versus-host disease (GVHD) and chronic GVHD were 25% and 10%, respectively. All patients had neutrophil recovery (median, 18.5 days) and all but 3 had platelet recovery (median, 12 days). Twenty-two percent had viral or systemic fungal infection within 100 days after allo-HCT. The 100-day and 1-year cumulative incidences of NRM were 16% and 21%, respectively, for ALL patients and 15% and 33%, respectively, for NHL/CLL patients. In ALL patients, later utilization of allo-HCT after CAR-T therapy was associated with higher mortality. In NHL/CLL patients, MAC was associated with higher mortality. Toxicities did not exceed the expected incidences in this high-risk population. •The toxicity of allo-HCT in patients with prior CAR-T therapy was not higher than what is expected in these high-risk patients.•In ALL patients, there seems to be a benefit from earlier utilization of allo-HCT after CAR-T therapy. Display omitted