Hemoadsorption as a Supportive Strategy for Severe Toxicity Associated With Chimeric Antigen Receptor T-Cell Therapy:...

To describe the use and effects of extracorporeal blood purification with hemoadsorption in managing severe complications after treatment with chimeric antigen receptor T-cells (CAR-T).

Retrospective analysis of a case series.

Hematological department and intensive care unit from a single institution. Patients with hematological cancer who underwent CAR-T therapy between 2021 and 2023, developed severe toxicity, and were treated with hemoadsorption based on clinical indications.

Of 48 patients, extracorporeal blood purification was prescribed to 4 (8.3%): 3 with diffuse large B-cell lymphoma and 1 with mantle cell lymphoma. These patients experienced rapid increases in serum interleukin-6 and ferritin levels after CAR-T infusion, which progressed to severe cytokine release syndrome with hemodynamic instability and multiple-organ toxicity. Despite corticosteroid and anakinra rescue therapy after tocilizumab failure, extracorporeal blood purification with hemoadsorption was initiated at a mean of 5.2 ± 1.7 days following CAR-T infusion due to rapid clinical deterioration. The treatment was performed using continuous venovenous hemodiafiltration with an AN69ST hemofilter and a CytoSorb cartridge. One patient died 1 day after the initiation of blood purification because of concomitant cardiomyopathy progressing to multiple-organ failure. In the 3 surviving patients, interleukin-6 levels significantly decreased (from -18% to -95%), cytokine release syndrome resolved, and vasoactive support was reduced. Treatment-related complications were not observed.

Small sample size, retrospective design, and lack of a predefined hemoadsorption therapy protocol.

A strategy based on hemoadsorption was safe and effective in mitigating inflammation and improving hemodynamics in patients with hematological cancer treated with CAR-T therapy who developed early severe toxicity.