Dermatologic Adverse Events Following CD19-Directed CAR T-Cell Therapy in Hematologic Malignancies

CD19 CAR T-cell therapy is a significant advance in B-NHL and ALL. This study describes the incidence, onset, and factors of dermatologic adverse events (dAE) post-therapy.

A retrospective analysis at Memorial Sloan Kettering Cancer Center (4/2013-8/2020) identified 193 patients undergoing CD19 CAR T-cell therapy. We aimed to characterize dAEs post CAR T-cell therapy including the 100-day cumulative incidence, time to dAE onset, and associations with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

Eighty-two patients experienced 94 dAEs within the first 100 days (incidence: 0.42 (95% CI: 0.36-0.51) post CAR T-cell therapy. Common dAEs were rash (30.9%, n = 29) including maculopapular rash, inflammatory papules, and local erythema; infection (23.4%, n = 22) including cellulitis and folliculitis; and xerosis (16.0%, n = 15). Specific early onset dAEs included rash and chemotherapy-related events, eg, alopecia, mucositis (median 12- and 17-days postinfusion, respectively). Thrombocytopenic purpura and xerosis presented later (median 22-and 25-days). CRS and dAEs occurred in 33.5% of patients, with CRS preceding dAEs in 86% of cases. Among 15% with ICANS and dAEs, ICANS was antecedent in 67%.

dAEs following CAR T-cell therapy are common but mostly low-grade and often manifest within the initial month postinfusion.