地塞米松预防多发性骨髓瘤中 cilta-cel 后淋巴细胞过度扩增

Increased absolute lymphocyte count (ALC) may predict risk of treatment-related mortality and atypical neurologic events among patients receiving chimeric antigen receptor (CAR) T-cell therapies for relapsed/refractory multiple myeloma. In this study, we analyzed the clinical outcomes of patients receiving ciltacabtagene autoleucel (cilta-cel) at the Colorado Blood Cancer Institute, from September 2023 to January 2025. Baseline data were collected pre/post-CAR T-cell therapy. Patients were stratified into preintervention (treated September 2023 to July 2024) and intervention (treated August 2024 to January 2025; those with ALC >5 103/ L received 3 days of dexamethasone prophylaxis on first identification of elevated ALC).

In the preintervention group, 9 of 30 patients had peak ALC >5 103/ L; 5 of 9 (55. 6%) experienced atypical neurologic events and all 5 died (cilta-cel therapy-related complications). In the intervention group, 7 of 23 patients had peak ALC >5 103/ L and received dexamethasone; 1 of 7 had an atypical neurologic event; and 1 death occured (infectious complication, 9 months posttreatment). Dexamethasone prophylaxis in patients with ALC of >5 103/ L resulted in rapid ALC reduction.

Overall survival (OS) was significantly lower in preintervention patients with ALC of >5 103/ L vs intervention patients with ALC of >5 103/ L and patients with ALC of 5 103/ L (P = . 0013). ALC >5 103/ L (vs ALC 5 103/ L) was significantly associated with atypical neurologic events (odds ratio, 6. 8; P = . 0157) and lower OS (hazard ratio, 6. 2; P = . 0106).

In conclusion, ALC >5 103/ L after cilta-cel treatment predicted severe early neurologic events and high mortality risk. Dexamethasone prophylaxis demonstrated promise for risk mitigation.