Delayed Hematologic Toxicities Following Axicabtagene Ciloleucel and Tisagenlecleucel CAR-T Cell Therapy: A Retrospective Analysis of Lymphocytopenia, Neutropenia, and Thrombocytopenia

This study provides a 2024 update on survival outcomes and the frequency of hematologic complications, specifically lymphocytopenia, neutropenia, and thrombocytopenia, in patients treated with axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) CAR-T cell therapies. The study examined 56 patients diagnosed with diffuse large B-cell lymphoma who underwent CAR-T cell therapy from 2019 to March 2024. Among them, 34 patients received axi-cel (group A), and 22 patients were treated with tisa-cel (group B). The cumulative survival rate was calculated using the Kaplan-Meier method, while the occurrence of delayed cytopenias (beyond 60 days post-treatment) was assessed through follow-up blood tests, with grading based on the National Cancer Institute's Common Terminology Criteria for Adverse Events. The study cohort (n = 56) had a mean age of 55 years (range 46–64 years), a mean weight of 75 kg (range 52–98 kg), and a mean height of 161 cm (range 145–178 cm). Women comprised 49% of the group. The cumulative survival rates were 65.5% for axi-cel and 56.5% for tisa-cel, with incidences of lymphopenia, neutropenia, and thrombocytopenia recorded at 21.4%, 5.3%, and 12.5%, respectively. The mean disease-free survival was 19 months (SD = 14), and the mean survival time after treatment was 10 months (SD = 9). This analysis suggests that late-onset cytopenias following CAR-T cell therapy are relatively rare, though they may result from a variety of underlying mechanisms in vulnerable patients.