[Hematologic side effects of cell and immunotherapy]

Area of Science:

• Oncology
• Immunology
• Hematology

Background:

• Cancer immunotherapies, including CAR T-cell therapy and immune checkpoint inhibitors, have transformed cancer treatment.
• These therapies induce distinct immune-mediated toxicities compared to conventional chemotherapy.
• Hematologic complications are a significant concern within these immune-related adverse events.

Purpose of the Study:

• To review the distinct hematologic toxicities associated with CAR T-cell therapy (ICAHT) and immune checkpoint inhibitors (CPI).
• To highlight the importance of differentiating these toxicities from disease progression or other hematologic malignancies.
• To outline diagnostic and management strategies for hematologic immune-related adverse events.

Main Methods:

• Review of immune-mediated hematologic complications from CAR T-cell therapy and CPI.
• Discussion of diagnostic challenges and differentiation from other causes of cytopenias.
• Summary of current management approaches, including supportive care and immunomodulatory treatments.

Main Results:

• Hematologic immune-related adverse events (irAEs) under CPI are rare but severe.
• Hematologic toxicities (ICAHT) are common after CAR T-cell therapy, presenting early or late.
• Severe syndromes like immune effector cell-associated hemophagocytic syndrome (IEC-HS) can occur, requiring prompt intervention.

Conclusions:

• Hematologic toxicities are a critical consideration in cellular and immunological cancer therapies.
• A structured diagnostic approach is essential for accurate identification and management.
• Interdisciplinary collaboration and timely intervention are crucial for optimizing patient outcomes.