Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
Click the orange button to the right to learn more about what you can start doing today.
- You are here:
- Home »
- Blog »
- Multiple Myeloma »
- Cytopenia Following CAR-T Cell Therapy
Cytopenia Following CAR-T Cell Therapy
According to the research linked below cytopenia following CAR-T cell therapy is the most frequent condition listed in the Common Terminology Criteria for Adverse Events of grade 3 or greater associated with CAR T-cell therapy.1-3
Though CAR-T cell therapy holds a great deal of promise for myeloma survivors, as of 2024, this therapy continues to cause serious side effects. As a MM survivor myself who’s spent decades struggling with long-term and late stage side effects, I believe that MM patients must understand their risks thoroughly before undergoing any therapy.
Having said that, I believe that as long as the MM patient understands his/her risks when undergoing a specific therapy, they can choose whatever therapy they please.
What therapies can myeloma patients undergo for cytopenia post CAR-T cell therapy?
1. Supportive Care Measures
- Blood Transfusions:
- Red Blood Cells (RBCs): Administered to manage anemia and alleviate symptoms like fatigue and weakness.
- Platelets: Given to patients with thrombocytopenia to reduce the risk of bleeding.
- Infection Prophylaxis:
- Antibiotics, Antivirals, and Antifungals: Prophylactic medications may be necessary, especially if neutropenia (low neutrophil count) is present, to prevent opportunistic infections.
- Immunoglobulin Replacement Therapy:
- Intravenous or Subcutaneous Immunoglobulins: For patients with hypogammaglobulinemia to reduce the risk of infections.
2. Pharmacologic Treatments
- Growth Factors:
- Granulocyte Colony-Stimulating Factor (G-CSF): Such as filgrastim or pegfilgrastim, to stimulate the production of neutrophils and reduce the duration of neutropenia.
- Erythropoiesis-Stimulating Agents (ESAs): Like erythropoietin or darbepoetin, to enhance red blood cell production in anemic patients.
- Thrombopoietin Receptor Agonists:
- Agents such as Romiplostim or Eltrombopag: These can be used to stimulate platelet production in patients with persistent thrombocytopenia.
- Corticosteroids:
- Used in Cases of Immune-Mediated Cytopenias: If cytopenias are suspected to be due to autoimmune mechanisms, corticosteroids may help suppress the immune response.
3. Advanced Interventions
- Hematopoietic Growth Factors:
- Agents that Promote Bone Marrow Recovery: In cases where bone marrow suppression is prolonged, additional agents may be considered under clinical guidance.
- Stem Cell Support:
- Hematopoietic Stem Cell Transplantation (HSCT): While not commonly performed solely for post-CAR-T cytopenias, HSCT might be an option if cytopenias are severe and refractory to other treatments, or if there’s disease relapse.
- Investigational Therapies:
- Clinical Trials: Participation in clinical trials exploring new agents or combinations aimed at accelerating bone marrow recovery and managing cytopenias may be beneficial for some patients.
4. Monitoring and Ongoing Care
- Regular Blood Counts: Frequent monitoring of complete blood counts (CBC) to assess the severity and progression of cytopenias.
- Tailored Treatment Plans: Collaborating with a hematologist or oncologist to customize therapies based on the type and severity of cytopenias, patient’s overall health, and response to initial treatments.
- Avoidance of Additional Myelosuppressive Agents: Limiting the use of medications that can further suppress bone marrow function unless absolutely necessary.
5. Patient Education and Support
- Educating Patients: Informing patients about signs of infection, bleeding, and other complications associated with cytopenias.
- Support Services: Providing access to nutritionists, physical therapists, and mental health professionals to support overall well-being during recovery.
There are a number of polyphenols that have been shown to enhance blood health in myeloma patients. However, I have no idea if these polyphenols can help cytopenia following CAR-T cell therapy.
However, if you are interested in learning more about nutritional supplementation that may help cytopenia following CAR-T cell therapy email me at David.PeopleBeatingCancer@gmail.com
thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
What Is Cytopenia?
“Overview
Cytopenia occurs when one or more of your blood cell types is lower than it should be.
Your blood consists of three main parts. Red blood cells, also called erythrocytes, carry oxygen and nutrients around your body. White blood cells, or leukocytes, fight infection and battle unhealthy bacteria. Platelets are essential for clotting. If any of these elements are below typical levels, you may have cytopenia…”
Management of Cytopenia Post CAR T-Cell Therapy
“Although the extensive study of potentially life-threatening toxicities, such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome, has informed the iterative development of effective risk evaluation and mitigation strategies over the years, similar advancements have not been achieved for hematological toxicities.
Despite the wealth of pivotal trials and real-world data highlighting the significance of cytopenia following CAR T-cell therapy, this area remains relatively unexplored…2
Cytopenia, which affects 1 or more cell lineages, is the most frequent condition listed in the Common Terminology Criteria for Adverse Events of grade 3 or greater associated with CAR T-cell therapy.1-3
Although the underlying pathophysiology remains to be fully elucidated, cytopenia appears to be a class effect of CAR T-cell therapy, independent of the target antigen or disease entity.3
Furthermore, this effect is characterized by profound and persistent cytopenia, often spanning months to years after CAR T-cell infusion, with periods of intermittent count recovery.4
The management of cytopenia post CAR T-cell therapy is primarily supportive and includes packed red blood cell (PRBC) and/or platelet transfusions, granulocyte colony-stimulating factor (G-CSF), thrombopoietin receptor agonists (TPO-RA), and hematopoietic stem cell boost (HSCB).1,2..
The concept of HSCB has long been utilized in transplantation to restore hematopoiesis.1 This approach can also be applied to patients experiencing persistent or life-threatening cytopenia after CAR T-cell therapy, provided the patient has a source of stored stem cells, typically from a previous transplant.
Three small, retrospective studies have explored the safety and feasibility of HSCBs after CAR T-cell therapy. Overall, HSCBs appear to be highly efficacious, with a majority of patients experiencing a sustained response in neutrophils and platelets within 2 to 3 weeks, and no AEs have been noted. However, there is wide variability in the timing of the boost and the cell dose.16-18…