CART Cell Therapy and Early Hemostatic Change
NEW prospective data suggest that hemostatic biomarkers may help identify which patients receiving chimeric antigen receptor T (CART) cell therapy are most likely to develop severe complications. In a cohort of 62 adults treated with CD19 or B cell maturation antigen (BCMA) targeted products, investigators tracked hemostatic changes from before lymphodepletion through 28 days after infusion.
The study focused on clinically important toxicities associated with CART cell therapy, including cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), thrombosis, and bleeding. CRS occurred in 94% of patients, while ICANS was reported in 39%. Venous thrombosis was uncommon at 1.6%, but clinically relevant bleeding occurred in 13% of patients, suggesting bleeding may represent a more immediate concern during the first month after infusion.
Biomarkers Linked to Severe Toxicity
Over the follow up period, patients showed prolonged coagulation times, thrombocytopenia, and reduced fibrinogen and P selectin levels. These findings point to a dynamic hemostatic response during treatment and recovery.
Several baseline biomarkers were associated with later complications. Higher endogenous thrombin potential at baseline was linked to a greater risk of clinically relevant CRS. Baseline C reactive protein (CRP) was associated with ICANS. Lower baseline P selectin levels and lower platelet counts identified patients at higher risk of bleeding.
These associations suggest that hemostatic profiling before infusion could offer a practical way to stratify risk before toxicity becomes clinically apparent.
Why This Matters for Practice
The findings are notable because thrombotic complications are often emphasized in cancer care, yet this analysis found that bleeding exceeded thrombosis in the first month after CART cell therapy. That shift has implications for monitoring, supportive care, and early intervention.
Although the study was relatively small, it highlights a clinically useful message: thrombin generation assay, CRP, platelet count, and P selectin may help identify patients at higher risk of severe toxicity or bleeding. Earlier recognition of these patients could support more targeted surveillance and faster management during a period when complications can escalate quickly.
Reference
Panizo-Inogés M et al. Haemostatic changes during CART cell therapy and risk of complications. Cancer Immunology, Immunotherapy. 2026;75:130.
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