Allogeneic CD34+ Selected Hematopoietic Stem Cell Boost Following CAR T-cell Therapy in a Patient with Prolonged Cytopenia and Active Infection

Abstract

Hematological toxicity (hematotoxicity) is the most common long-term adverse effect following the use of CD19-chimeric antigen receptor (CD19-CAR) T-cell therapies. However, its management remains unclear. We present the case of a 21-year-old who received CD19-CAR T-cell therapy for relapse following a haploidentical transplant. He developed hematotoxicity and consequently multiple life-threatening infections. We administered a CD34+ hematopoietic stem cell boost (HSCB) from his transplant donor that led to hematopoietic recovery and resolution of his infections without any effect on the activity of CD19-CAR T cells. CD34+ HSCB can be a safe and effective option to treat hematotoxicity following CD19-CAR T-cell therapy.