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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Tuesday, January 21, 2025
Early hematologic toxicity, as measured by the Hematotox score, is predictive of hematologic recovery—but not survival outcomes—in patients receiving chimeric antigen receptor (CAR) T-cell therapy for relapsed or refractory diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma, and multiple myeloma. Despite its predictive value for early toxicity, the Hematotox score shows limitations in prognosticating long-term survival, highlighting the need for refined scoring systems to better stratify risk and guide management in patients receiving this type of therapy. Vadim Lesan, MD, of Saarland University Hospital, Homburg, Germany, and colleagues published their findings in Frontiers in Medicine.
In this single-center, the investigators included all patients treated with CAR T-cell products for relapsed or refractory DLBCL, mantle cell lymphoma, and multiple myeloma. The treatment period reported here is between April 2022 and February 2024. The investigators retrospectively evaluated early hematologic toxicity and the prognostic utility of the Hematotox score in patients undergoing CAR T-cell therapy. Hematologic parameters—including hemoglobin, platelet, and neutrophil counts, along with markers like ferritin and lactate dehydrogenase (LDH)—were analyzed during and after cytokine-release syndrome.
The investigators found a strong negative correlation between the Hematotox score and platelet count on the first day of cytokine-release syndrome, indicating that higher scores were associated with lower platelet levels (r = −0.71, P = .001). The Hematotox score also predicted hemoglobin levels at day 28 after CAR T-cell therapy, suggesting its utility in assessing early hematologic recovery (r = −0.5, P = .01). Additionally, patients with high Hematotox scores exhibited persistently elevated ferritin levels 28 days after therapy. However, there was no significant association between early hematologic parameters (hemoglobin, platelet, and neutrophil counts), ferritin, or LDH levels at the onset of cytokine-release syndrome and mortality. Of note, the Hematotox score itself did not correlate with survival outcomes, as previously mentioned.
Disclosure: The study authors reported no conflicts of interest.
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