CAR-T recipients report higher rates of ‘potentially serious’ toxicities
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Key takeaways:
- Toxicities related to CAR-T extend beyond CRS and anemia in patients with relapsed or refractory lymphoma.
- More research into amplification of neurologic effects is warranted.
Individuals with relapsed or refractory lymphoma who received chimeric antigen receptor T-cell therapy experienced a wide range of adverse events compared with those who received other treatments, study results showed.
Whereas cytokine release syndrome and anemia are common toxicities related to CAR-T, others can occur too, including neurologic effects such as difficulty speaking or writing, sexual and intimacy problems, hair loss, and more, according to findings presented at European Society for Blood and Marrow Transplantation-European Hematology Association 6th European CAR T-cell Meeting.
“The highly incident side effects of CAR-T are known,” Steve Kalloger, MSc, head of research at Lymphoma Coalition, Canada, told Healio. “However, due to a paucity of data, less common but potentially serious side effects are only being discovered with more data being examined. Patients who are treated with CAR-T should be actively monitored for a wide range of side effects so that we have the data to predict who is likely to experience a particular side-effect profile.”
Use of CAR-T has risen in individuals with relapsed or refractory lymphoma, but it is still a novel treatment approach so data on adverse events are limited, according to background information provided by researchers.
“We felt that side-effect incidence has taken a back seat to efficacy,” Kalloger said.
“A goal of this research was to explore the experience of patients who have received CAR-T to better understand which side effects were experienced,” he added. “We are especially interested in the identification of emerging side effects that are less common than cytokine release syndrome or anemia.”
Kalloger and colleagues built their study cohort using respondent data from the global patient survey the Lymphoma Coalition began using in 2022.
They investigated the differences CAR-T had on 32 different adverse reactions compared with other treatments.
Survey respondents had relapsed or refractory mantle cell, Hodgkin, transformed follicular or diffuse large B-cell lymphoma.
The cohort consisted of 664 patients, 11% of whom received CAR-T. Patients with DLBCL made up 40% of the population, followed by Hodgkin (35%), mantle cell (17%) and follicular (8%) lymphoma.
Researchers reported a significantly higher incidence among those who received CAR-T for eight of the 32 adverse events studied — CRS, neurologic effects, anemia, diarrhea, sexual and intimacy problems, neutropenia, hair loss, and eyesight issues. Additionally, they determined a borderline significance in memory loss.
“We suspected that CAR-T therapy would amplify side effects, but we were surprised at the breadth of the individual side effects,” Kalloger said. “The impact on neurologic effects (difficulty writing, speaking) was of interest and begged the question of how long these may last.”
CAR-T recipients should receive “increased surveillance” to account for these adverse events, Kalloger explained, and he hopes future research investigates duration of these reactions and which patient populations are most at risk.
“Any new therapy is going to see an influx of interest if, as in CAR-T, it appears to have a high rate of efficacy,” Kalloger said.
“The stories of transforming outcomes for terminal diseases are told by the survivors and there is a bias to favor life extension over quality of life,” he added. “As more therapies come to the forefront, there will be [more] choices for both patients and their treating physicians. We envision a not-too-distant future where patient preference for side effect avoidance will have equal footing with the quest for improved prognosis. With more people [receiving] CAR-T, we hope to get a more accurate picture of the patient experience, which can inform clinical care.”
For more information:
Steve Kalloger, MSc, can be reached at steve@lymphomacoalition.org.
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Bolanos N, et al. An assessment side-effect incidence for those receiving CAR-T versus other treatments in the setting of relapsed or refractory disease. Presented at: European Society for Blood and Marrow Transplantation-European Hematology Association 6th European CAR T-cell Meeting; Feb. 15-17, 2024; Valencia, Spain.
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