Impact of Granulocyte Colony Stimulating Factor Use Following CD-19 Chimeric Antigen Receptor T-Cell Therapy

Area of Science:

• Hematology
• Oncology
• Immunotherapy

Background:

• CD-19 CAR-T cell therapy offers improved outcomes for B-cell malignancies.
• CAR-T therapy is associated with toxicities like CRS and ICANS.
• Neutropenia is a common complication, and G-CSF use post-CAR-T is debated due to potential toxicity risks.

Purpose of the Study:

• To evaluate the impact of early (≤14 days) versus late/no G-CSF use on CRS and ICANS development after CAR-T therapy.
• To compare neutropenia outcomes, including duration and incidence, between early and late/no G-CSF cohorts.

Main Methods:

• Retrospective study of 157 adult patients receiving commercial anti-CD-19 CAR-T therapy.
• Patients divided into early (first G-CSF ≤ d+14) and late/no G-CSF cohorts.
• Primary outcomes: incidence of CRS and ICANS. Secondary outcomes: severity, duration of neutropenia, and neutropenia incidence.

Main Results:

• No significant difference in CRS or ICANS incidence between early and late/no G-CSF groups after adjustment.
• Higher-grade CRS was more frequent in the early group, but not statistically significant.
• Duration and incidence of neutropenia were similar between groups.

Conclusions:

• Using G-CSF within 14 days post-CAR-T does not appear to increase the risk of CRS or ICANS.
• G-CSF use did not demonstrate significant benefits in improving neutropenia outcomes.
• The utility of G-CSF for managing neutropenia post-CAR-T warrants further investigation.