Venous Thromboembolism in Aggressive B-Cell Lymphoma Patients Treated with CD19 CAR-T Therapy: Single-Institution...

Large B-cell lymphomas (LBCLs) are a common subtype of non-Hodgkin lymphomas. CD19 chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized LBCL treatment, with high remission rates but also significant toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Venous thromboembolism (VTE) in CAR-T therapy patients is understudied.

This study aims to determine the incidence and characteristics of acute VTE in LBCL patients treated with CAR-T therapy and identify baseline clinical features associated with VTE. Methods: We retrospectively reviewed 172 adult LBCL patients treated with CAR-T therapy from January 2018 to November 2019 at MD Anderson Cancer Center. Data on demographics, clinical characteristics, and adverse events were collected. VTE events within 6 months post-CAR-T therapy were confirmed by diagnostic imaging. Statistical analyses included univariate analyses and cumulative incidence functions.

The cohort was predominantly male (70%), with a median age of 59 years and advanced-stage disease (76.16%). The 6-month incidence of VTE was 7.6%, primarily involving upper extremity events related to central venous catheters. Significant associations were found between VTE and disease histology (p = 0.033) and high-grade ICANS (p = 0.013). PMBCL patients had a higher VTE incidence (30%) compared to DLBCL and TFL. Most VTE events occurred within the first month post-CAR-T therapy.

LBCL patients receiving CAR-T therapy have a significant risk of VTE, particularly within the first month and among those with PMBCL and high-grade ICANS. This highlights the need to study the role of venous thromboprophylaxis in this context.