Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

‘Save the day with a Stem Cell Rescue’: Use of autologous hematopoietic stem cell boost for hematopoietic recovery after CAR T cell therapy

Bone Marrow Transplantation volume 57, pages 504–506 (2022)Cite this article

Subjects

Chimeric antigen receptor (CAR) T cell therapy is an emerging treatment option for patients with relapsed/refractory multiple myeloma. Neutropenia, anemia, and thrombocytopenia are common and challenging hematological toxicities after CAR T cell therapy that can take months to recover. We present two unique cases of multiple myeloma with post CAR T severe and persistent cytopenias that quickly recovered hematopoiesis after hematopoietic stem cell boosts. To our knowledge, these are the first reported cases of post CAR T cytopenias effectively and efficiently treated with stem cell boosts.

A 67-year-old female with IgG lambda multiple myeloma refractory to four prior lines of therapy including an anti-CD38 monoclonal antibody, two immunomodulatory agents, two proteasome inhibitors (penta-refractory), and an ASCT received idecabtagene vicleucel infusion (416.99 × 106 cells) after Flu Cy lymphodepletion. Post infusion, the patient developed grade 1 CRS requiring tocilizumab (three doses) and grade 1 ICANS (no corticosteroids). The patient subsequently experienced grade 4 cytopenias and received supportive care with filgrastim 5 mcg/kg three times weekly (day + 14 onwards), romiplostim (day + 23 onwards), and red blood cells/platelet transfusions without adequate count recovery. Post CAR T day +30 assessment was consistent with stringent CR with no evidence of clonal plasma cells or myelodysplasia on the bone marrow biopsy. With ongoing cytopenias on day +53, the patient received a boost with previously collected 2.22 × 106 cells/kg hematopoietic stem cells followed by daily filgrastim 5 mcg/kg for 14 days. Within 14 days of the boost, the patient started showing signs of hematopoietic recovery with resolution neutropenia by day +80. At the last follow-up (day + 120), blood counts continue to improve and myeloma remained in stringent CR (Fig. 1).

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Time to event graph showing recovery of hematopoiesis.

References

  1. Logue JM, Zucchetti E, Bachmeier CA, Krivenko GS, Larson V, Ninh D, et al. Immune reconstitution and associated infections following axicabtagene ciloleucel in relapsed or refractory large B-cell lymphoma. Haematologica 2021;106:978–86.

    Article  CAS  Google Scholar 

  2. Nahas GR, Komanduri KV, Pereira D, Goodman M, Jimenez AM, Beitinjaneh A, et al. Incidence and risk factors associated with a syndrome of persistent cytopenias after CAR-T cell therapy (Pctt). Leuk Lymphoma. 2020;61:940–3.

    Article  CAS  Google Scholar 

  3. Jain T, Knezevic A, Pennisi M, Chen Y, Ruiz JD, Purdon TJ, et al. Hematopoietic recovery in patients receiving chimeric antigen receptor T-cell therapy for hematologic malignancies. Blood Adv. 2020;4:3776–87.

    Article  CAS  Google Scholar 

  4. Munshi NC, Anderson LD, Shah N, Madduri D, Berdeja J, Lonial S, et al. Idecabtagene vicleucel in relapsed and refractory multiple myeloma. N Engl J Med. 2021;384:705–16.

    Article  CAS  Google Scholar 

  5. Cordeiro A, Bezerra ED, Hirayama AV, Hill JA, Wu QV, Voutsinas J, et al. Late events after treatment with cd19-targeted chimeric antigen receptor modified t cells. Biol Blood Marrow Transpl. 2020;26:26–33.

    Article  CAS  Google Scholar 

  6. Neelapu SS, Tummala S, Kebriaei P, Wierda W, Gutierrez C, Locke FL, et al. Chimeric antigen receptor T-cell therapy - assessment and management of toxicities. Nat Rev Clin Oncol. 2018;15:47–62.

    Article  CAS  Google Scholar 

  7. Wang L, Hong R, Zhou L, Ni F, Zhang M, Zhao H, et al. New-onset severe cytopenia after car-t cell therapy: analysis of 76 patients with relapsed or refractory acute lymphoblastic leukemia. Front Oncol. 2021;11:702644.

    Article  Google Scholar 

  8. Klyuchnikov E, El-Cheikh J, Sputtek A, Lioznov M, Calmels B, Furst S, et al. CD34(+)-selected stem cell boost without further conditioning for poor graft function after allogeneic stem cell transplantation in patients with hematological malignancies. Biol Blood Marrow Transpl. 2014;20:382–6.

    Article  CAS  Google Scholar 

  9. Stiff PJ, Micallef I, Nademanee AP, Stadtmauer EA, Maziarz RT, Bolwell BJ, et al. Transplanted CD34(+) cell dose is associated with long-term platelet count recovery following autologous peripheral blood stem cell transplant in patients with non-Hodgkin lymphoma or multiple myeloma. Biol Blood Marrow Transpl. 2011;17:1146–53.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology and Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA

    Hamza Hashmi, Abigail Shockley & James A. Davis

Authors
  1. Hamza Hashmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abigail Shockley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James A. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HH conceived, composed, edited and finalized the paper. AS compiled and edited data and figures. JD composed, edited and finalized the paper.

Corresponding author

Correspondence to Hamza Hashmi.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hashmi, H., Shockley, A. & Davis, J.A. ‘Save the day with a Stem Cell Rescue’: Use of autologous hematopoietic stem cell boost for hematopoietic recovery after CAR T cell therapy. Bone Marrow Transplant 57, 504–506 (2022). https://doi.org/10.1038/s41409-022-01570-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-022-01570-4

This article is cited by

Search

Advanced search

Quick links