Hematopoiesis and immune reconstitution after CD19 directed chimeric antigen receptor T‐cells (CAR‐T): A comprehensive review on incidence, risk factors and current management

Eugenio Galli, Alberto Fresa, Silvia Bellesi, Elisabetta Metafuni, Elena Maiolo, Ilaria Pansini, Filippo Frioni, Francesco Autore, Maria Assunta Limongiello, Idanna Innocenti, Sabrina Giammarco, Patrizia Chiusolo, Gina Zini Tanzi, Federica Sora'

Research output: Contribution to journalArticle

Abstract

Impaired function of hematopoiesis after treatment with chimeric antigen T-cells (CAR-T) is a frequent finding and can interest a wide range of patients, regardless of age and underlying disease. Trilinear cytopenias, as well as hypogammaglobulinemia, B-cell aplasia, and T-cell impairment, can severely affect the infectious risk of CAR-T recipients, as well as their quality of life. In this review, we provide an overview of defects in hematopoiesis after CAR-T, starting with a summary of different definitions and thresholds. We then move to summarize the main pathogenetic mechanisms of cytopenias, and we offer insight into cytomorphological aspects, the role of clonal hematopoiesis, and the risk of secondary myeloid malignancies. Subsequently, we expose the major findings and reports on T-cell and B-cell quantitative and functional impairment after CAR-T. Finally, we provide an overview of current recommendations and leading experiences regarding the management of cytopenias and defective B- and T-cell function.
Original languageEnglish
Pages (from-to)184-196
Number of pages13
JournalEuropean Journal of Haematology
Volume112
DOIs
Publication statusPublished - 2024

Keywords

  • CAR-T cells
  • hypogammaglobulinemia
  • hematopoiesis
  • cytopenia

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