Chimeric antigen receptor (CAR)-T cell therapy, a new immunotherapy for relapsed and refractory (R/R) hematologic malignancies, can be accompanied by adverse events, including coagulation disorders. Here, we performed a comprehensive analysis of coagulation parameters in 100 patients with R/R hematologic malignancies after receiving CAR-T cell therapy to illuminate the profiles of coagulation disorders and to facilitate the management of coagulation disorders. A high incidence of coagulation disorders was observed, including elevated D-dimer (50/100, 50%), increased fibrinogen degradation product (45/100, 45%), decreased fibrinogen (23/100, 23%), prolonged activated partial thromboplastin time (16/100, 16%), and prolonged prothrombin time (10/100, 10%). Coagulation disorders occurred mainly during day 6 to day 20 after CAR-T cell infusion. The changes in coagulation parameters were associated with high tumor burden in acute lymphoblastic leukemia, more lines of prior therapies, lower baseline platelet count, and especially cytokine release syndrome (CRS). Disseminated intravascular coagulation (DIC) was found in 7 patients with grade ≥3 CRS and indicated a poor prognosis. Our study suggests that coagulation disorders are manageable in most patients after CAR-T cell therapy. Coexistence of DIC and severe CRS is closely related to nonrelapsed deaths during the acute toxicity phase, and effective and timely treatment is the key to reduce nonrelapse mortality for patients with DIC and severe CRS.

中文翻译：

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嵌合抗原受体 T 细胞治疗后的凝血障碍：100 例复发和难治性血液系统恶性肿瘤患者的分析。

嵌合抗原受体 (CAR)-T 细胞疗法是一种治疗复发性和难治性 (R/R) 恶性血液病的新型免疫疗法，它可能伴随着不良事件，包括凝血障碍。在这里，我们对 100 名接受 CAR-T 细胞治疗的 R/R 血液系统恶性肿瘤患者的凝血参数进行了全面分析，以阐明凝血障碍的概况并促进凝血障碍的管理。观察到凝血障碍的发生率很高，包括 D-二聚体升高（50/100, 50%），纤维蛋白原降解产物增加（45/100, 45%），纤维蛋白原减少（23/100, 23%），活化部分延长凝血活酶时间（16/100, 16%）和凝血酶原时间延长（10/100, 10%）。凝血障碍主要发生在 CAR-T 细胞输注后的第 6 天至第 20 天。凝血参数的变化与急性淋巴细胞白血病的高肿瘤负荷、更多的先前疗法、较低的基线血小板计数，尤其是细胞因子释放综合征 (CRS) 相关。7 例≥3 级 CRS 患者出现弥散性血管内凝血（DIC），提示预后不良。我们的研究表明，大多数患者在接受 CAR-T 细胞治疗后，凝血障碍是可以控制的。DIC与重症CRS并存与急性毒性期非复发死亡密切相关，有效及时的治疗是降低DIC与重症CRS患者非复发死亡率的关键。尤其是细胞因子释放综合征（CRS）。7 例≥3 级 CRS 患者出现弥散性血管内凝血（DIC），提示预后不良。我们的研究表明，大多数患者在接受 CAR-T 细胞治疗后，凝血障碍是可以控制的。DIC与重症CRS并存与急性毒性期非复发死亡密切相关，有效及时的治疗是降低DIC与重症CRS患者非复发死亡率的关键。尤其是细胞因子释放综合征（CRS）。7 例≥3 级 CRS 患者出现弥散性血管内凝血（DIC），提示预后不良。我们的研究表明，大多数患者在接受 CAR-T 细胞治疗后，凝血障碍是可以控制的。DIC与重症CRS并存与急性毒性期非复发死亡密切相关，有效及时的治疗是降低DIC与重症CRS患者非复发死亡率的关键。