Transfusion support after CAR-T cell therapy: Real-world patterns across commercial products and disease groups

Area of Science:

• Hematology
• Oncology
• Immunotherapy

Background:

• Chimeric antigen receptor (CAR) T-cell therapy can cause prolonged cytopenias, necessitating transfusions.
• Limited real-world data exist on transfusion burden across different commercial CAR-T products.
• The risk of post-therapy alloimmunization requires further investigation.

Purpose of the Study:

• To compare real-world transfusion burden across five commercial CAR-T products.
• To assess the risk of alloimmunization after CAR-T therapy.
• To analyze transfusion patterns in relation to CAR-T product and disease group.

Main Methods:

• Retrospective review of 102 patients receiving idecabtagene vicleucel, ciltacabtagene autoleucel, lisocabtagene maraleucel, axicabtagene ciloleucel, or brexucabtagene autoleucel.
• Quantification of red blood cell (RBC) and platelet transfusions at 0-30, 30-90, and 90-180 days post-infusion.
• Statistical analysis using Kruskal-Wallis tests and negative binomial regression; alloimmunization assessed via antibody screening.

Main Results:

• No significant product-specific differences were detected in RBC transfusion requirements.
• Platelet transfusion patterns varied by product and disease, but these findings are hypothesis-generating due to small patient counts.
• No new RBC alloantibodies were identified through routine clinical screening.

Conclusions:

• Transfusion requirements post-CAR-T therapy are typically modest and concentrated within the first 30 days.
• This analysis provides real-world insights into transfusion support across commercial CAR-T products and disease groups.
• Observed product- and disease-related differences in transfusion needs are likely driven by a minority of patients and require further investigation; no new RBC alloantibodies were detected.