Routine Monitoring of CAR-T-Cells Expansion and Persistence in Patients With Aggressive Large B-Cell Lymphoma by Flow...

Area of Science:

• Immunology
• Hematology
• Oncology

Background:

• Chimeric antigen receptor T-cell (CAR-T) therapy is a promising treatment for aggressive large B-cell lymphoma (LBCL).
• Monitoring CAR-T-cell kinetics and associated toxicities is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the utility of routine flow cytometry (FC) for monitoring CAR-T-cell expansion in LBCL patients.
• To correlate CAR-T-cell expansion levels with immune-related toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

Main Methods:

• Retrospective, single-center study of 45 LBCL patients receiving CAR-T therapy.
• Flow cytometry was used to assess CAR-T-cell expansion from Day 0 to Month 12 post-infusion.
• Immune-related toxicities (CRS, ICANS) and cytopenia were recorded and analyzed in relation to CAR-T-cell levels.

Main Results:

• Peak CAR-T-cell expansion occurred around Day 7-10 post-infusion, varying by product (axi-cel vs. tisa-cel).
• Greater CAR-T-cell expansion was significantly associated with higher incidence and severity of CRS (p < 0.001) and ICANS (p < 0.001).
• Prolonged cytopenia was observed in 65% of patients, more frequent in those with higher CAR-T-cell expansion.

Conclusions:

• Routine flow cytometry is a practical method for monitoring CAR-T-cell dynamics in clinical practice.
• CAR-T-cell expansion levels can serve as an early indicator for potential immune-related toxicities.
• Findings support personalized supportive care strategies based on monitored CAR-T-cell expansion and toxicity risk.