Incidence, management and outcomes of arterial and venous thrombosis after chimeric antigen receptor modified T cells for B cell lymphoma and multiple myeloma

Parks, Anna L.; Kambhampati, Swetha; Fakhri, Bita; Andreadis, Charalambos; Gray, Lissa; Wong, Sandy W.; Shah, Nina; Fang, Margaret C.

doi:10.1080/10428194.2020.1852474

Cited by 10 publications

(9 citation statements)

References 11 publications

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“… 45 An ~10% incidence of VTE within 60 days of initiating CAR‐T cell therapy was observed in a retrospective analysis of 91 patients with non‐Hodgkin lymphoma or multiple myeloma. 46 However, another retrospective study observed a much lower risk of thrombosis (~2%) with CAR therapy, but the patients in this study had high rate of pharmacological thromboprophylaxis. 47 Other therapies can accompany CAR‐T, such as radiotherapy, which can also contribute to thrombotic risk.…”

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 61%

“…A retrospective review of 127 patients with B‐cell leukemia or lymphoma receiving CAR therapies noted bleeding and thrombotic complications in ~10% and 6% of patients, respectively 45 . An ~10% incidence of VTE within 60 days of initiating CAR‐T cell therapy was observed in a retrospective analysis of 91 patients with non‐Hodgkin lymphoma or multiple myeloma 46 . However, another retrospective study observed a much lower risk of thrombosis (~2%) with CAR therapy, but the patients in this study had high rate of pharmacological thromboprophylaxis 47 .…”

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 99%

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Hemostasis and tumor immunity

Cantrell

Palumbo

2022

Research and Practice in Thrombosis and Haemostasis

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Significant data have accumulated demonstrating a reciprocal relationship between cancer and the hemostatic system whereby cancer promotes life‐threatening hemostatic system dysregulation (e.g., thromboembolism, consumptive coagulopathy), and hemostatic system components directly contribute to cancer pathogenesis. The mechanistic underpinnings of this relationship continue to be defined, but it is becoming increasingly clear that many of these mechanisms involve crosstalk between the hemostatic and immune systems. This is perhaps not surprising given that there is ample evidence for bidirectional crosstalk between the hemostatic and immune systems at multiple levels that likely evolved to coordinate the response to injury, host defense, and tissue repair. Much of the data linking hemostasis and immunity in cancer biology focus on innate immune system components. However, the advent of adaptive immunity‐based cancer therapies such as immune checkpoint inhibitors has revealed that the relationship of hemostasis and immunity in cancer extends to the adaptive immune system. Adaptive immunity‐based cancer therapies appear to be associated with an increased risk of thromboembolic complications, and hemostatic system components appear to regulate adaptive immune functions through diverse mechanisms to affect tumor progression. In this review, the evidence for crosstalk between hemostatic and adaptive immune system components is discussed, and the implications of this relationship in the context of cancer therapy are reviewed. A better understanding of these relationships will likely lead to strategies to make existing adaptive immune based therapies safer by decreasing thromboembolic risk and may also lead to novel targets to improve adaptive immune‐based cancer treatments.

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Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 61%

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 99%

Hemostasis and tumor immunity

Cantrell

Palumbo

2022

Research and Practice in Thrombosis and Haemostasis

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“…No information regarding CRS was provided. 42 A case report of a relapsed refractory MM patient treated with both CD19-and BCMA-CAR-T cells described development of a large lower limb deep-vein thrombosis. (DVT) in association with coagulopathy with thrombocytopenia, prolonged PT and APTT.…”

Section: Cy Tok I N E R E L E Ase Sy N Drom E a N D T Hrom Bosismentioning

confidence: 99%

“…Within 60 days post infusion, VTE occurred in 9% of the study group overall, affecting 11% of the NHL patients and 7% of the MM group. No information regarding CRS was provided 42 . A case report of a relapsed refractory MM patient treated with both CD19‐ and BCMA‐CAR‐T cells described development of a large lower limb deep‐vein thrombosis.…”

Section: Risk Stratification For Thrombosis With Car‐t‐cell Therapymentioning

confidence: 99%

“…Whether VTE was more common in patients who did not receive any anticoagulation was not stated. 42 In a study of 148 patients with DLBCL, 16 patients (11%) had a new VTE diagnosed in the first 100 days following CAR‐T infusion, 25% of which were associated with a CVC. Routine thromboprophylaxis was not administered.…”

Section: Thromboprophylaxis During Car‐t Therapymentioning

confidence: 99%

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Management of haemostatic complications of chimaeric antigen receptor T‐cell therapy

Swan

Thachil²

2022

Br J Haematol

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Bleeding and Thrombotic Complications

Shah,

Savani,

Chaturvedi

2024

The EBMT Handbook

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Bleeding and thrombotic complications are an important cause of morbidity and mortality in patients undergoing hematopoietic cell transplantation (HCT). The major thrombotic complications include venous thromboembolism (VTE) including catheter-related thrombosis (CRT), sinusoidal obstruction syndrome (SOS), and transplant-associated thrombotic microangiopathy (TA-TMA), while bleeding commonly involves the gastrointestinal or respiratory tracts and is most common in thrombocytopenic patients or those with graft-versus-host disease (GVHD). HCT is associated with multiple risk factors for both thrombosis and bleeding including the underlying malignancy, thrombocytopenia, high-dose myeloablative chemotherapy (MAC) and immune-modulatory drugs, GVHD, infections, indwelling vascular catheters, and prolonged immobilization (Chiu and Lazo-Langner 2023; Gerber et al. 2008; Chaturvedi et al. 2016; Nadir and Brenner 2007). In addition, HCT is also associated with alterations in the coagulation system with activation of endothelium-dependent coagulation factors, increase in von Willebrand factor (vWF) and platelet adhesion, increased thrombin generation, decreased antithrombin levels, and decreased levels of anticoagulant proteins such as protein C (Vannucchi et al. 1994). Collectively, major patient-, disease-, and therapy-related factors contribute to hemostatic complications in HCT patients. Thrombotic and bleeding complications in HCT are discussed separately in the following section.

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Incidence, management and outcomes of arterial and venous thrombosis after chimeric antigen receptor modified T cells for B cell lymphoma and multiple myeloma

Cited by 10 publications

References 11 publications

Hemostasis and tumor immunity

Hemostasis and tumor immunity

Management of haemostatic complications of chimaeric antigen receptor T‐cell therapy

Bleeding and Thrombotic Complications

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