| Title: |
Hemoadsorption as a Supportive Strategy for Severe Toxicity Associated With Chimeric Antigen Receptor T-Cell Therapy: A Case Series |
| Authors: |
Esposito, Pasquale; Gambella, Massimiliano; Russo, Elisa; Raiola, Anna Maria; Beltrametti, Elena; Conti, Novella; Porcile, Elisa; Bianzina, Stefania; Centanaro, Monica; Viazzi, Francesca; Angelucci, Emanuele |
| Contributors: |
Esposito, Pasquale; Gambella, Massimiliano; Russo, Elisa; Raiola, Anna Maria; Beltrametti, Elena; Conti, Novella; Porcile, Elisa; Bianzina, Stefania; Centanaro, Monica; Viazzi, Francesca; Angelucci, Emanuele |
| Publisher Information: |
Elsevier Inc.; RADARWEG 29, 1043 NX AMSTERDAM, NETHERLANDS |
| Publication Year: |
2025 |
| Collection: |
Università degli Studi di Genova: CINECA IRIS |
| Subject Terms: |
B-cell lymphoma; CAR-T therapy; blood purification; cytokine release syndrome; hemoadsorption; interleukin-6 |
| Description: |
Rationale & Objective: To describe the use and effects of extracorporeal blood purification with hemoadsorption in managing severe complications after treatment with chimeric antigen receptor T-cells (CAR-T). Study Design: Retrospective analysis of a case series. Setting & Participants: Hematological department and intensive care unit from a single institution. Patients with hematological cancer who underwent CAR-T therapy between 2021 and 2023, developed severe toxicity, and were treated with hemoadsorption based on clinical indications. Results: Of 48 patients, extracorporeal blood purification was prescribed to 4 (8.3%): 3 with diffuse large B-cell lymphoma and 1 with mantle cell lymphoma. These patients experienced rapid increases in serum interleukin-6 and ferritin levels after CAR-T infusion, which progressed to severe cytokine release syndrome with hemodynamic instability and multiple-organ toxicity. Despite corticosteroid and anakinra rescue therapy after tocilizumab failure, extracorporeal blood purification with hemoadsorption was initiated at a mean of 5.2 ± 1.7 days following CAR-T infusion due to rapid clinical deterioration. The treatment was performed using continuous venovenous hemodiafiltration with an AN69ST hemofilter and a CytoSorb cartridge. One patient died 1 day after the initiation of blood purification because of concomitant cardiomyopathy progressing to multiple-organ failure. In the 3 surviving patients, interleukin-6 levels significantly decreased (from −18% to −95%), cytokine release syndrome resolved, and vasoactive support was reduced. Treatment-related complications were not observed. Limitations: Small sample size, retrospective design, and lack of a predefined hemoadsorption therapy protocol. Conclusions: A strategy based on hemoadsorption was safe and effective in mitigating inflammation and improving hemodynamics in patients with hematological cancer treated with CAR-T therapy who developed early severe toxicity. Plain Language Summary: Chimeric antigen receptor T-cell ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
ELETTRONICO |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40510619; info:eu-repo/semantics/altIdentifier/wos/WOS:001500941100007; volume:7; issue:6; firstpage:1; lastpage:6; numberofpages:6; journal:KIDNEY MEDICINE; https://hdl.handle.net/11567/1258038 |
| DOI: |
10.1016/j.xkme.2025.101001 |
| Availability: |
https://hdl.handle.net/11567/1258038; https://doi.org/10.1016/j.xkme.2025.101001 |
| Rights: |
info:eu-repo/semantics/openAccess |
| Accession Number: |
edsbas.9102A5E4 |
| Database: |
BASE |