A patient who has received CAR (chimeric antigen receptor) T-cell therapy may develop one or more cytopenias. These are often transient but can be persistent.
Cytopenias include any combination of:
(1) lymphopenia
(2) neutropenia
(3) anemia
(4) thrombocytopenia
The cytopenia is considered persistent if it continues> 28 days after the CAR T-cell infusion.
Bone marrow failure was defined as an absolute neutrophil count < 500 per µL on day 42 after infusion of CAR-T cells.
Predictors of persistent cytopenias:
(1) platelet count < 75,000 per µL at the initiation of lymphodepleting chemotherapy
(2) maximum severity of cytokine-release syndrome on day 0 or 1 after infusion of CAR T-cells
Recovery may take time (up to 240 days). Administration of growth factors (filgrastim) may raise counts, but these should not be given before 3 weeks after CAR T-cell infusion(in order to avoid the cytokine release syndrome).
Severe, persistent neutropenia may be associated with bacterial infections.
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