Perl, Markus and Herfeld, Konstantin and Harrer, Dennis C. and Hoepting, Matthias and Schweiger, Marina and Sterz, Ulrich and Knoedler, Leonard and Heimerl, Susanne and Hansmann, Leo and Herr, Wolfgang and Poeck, Hendrik and Wolff, Daniel and Edinger, Matthias and Hart, Christina and Fante, Matthias A. (2024) Tocilizumab administration in cytokine release syndrome is associated with hypofibrinogenemia after chimeric antigen receptor T-cell therapy for hematologic malignancies. HAEMATOLOGICA, 109 (9). pp. 2969-2977. ISSN 0390-6078, 1592-8721
Full text not available from this repository. (Request a copy)Abstract
Chimeric antigen receptor (CAR) T-cell therapy causes serious side effects including cytokine release syndrome (CRS). CRS-related coagulopathy is associated with hypofibrinogenemia that has up to now been considered the result of disseminated intravascular coagulation (DIC) and liver dysfunction. We investigated the incidence and risk factors for hypofibrinogenemia in 41 consecutive adult patients with hematologic malignancies (median age 69 years, range 38-83 years) receiving CAR T-cell therapy between January 2020 and May 2023 at the University Medical Center Regensburg. CRS occurred in 93% of patients and was accompanied by hypofibrinogenemia already from CRS grade 1. Yet DIC and liver dysfunction mainly occurred in severe CRS (>= grade 3). After an initial increase during CRS, fibrinogen levels dropped after administration of tocilizumab in a dose-dependent manner (r =-0.44, P =0.004). In contrast, patients who did not receive tocilizumab had increased fibrinogen levels. Logistic regression analysis identified tocilizumab as an independent risk factor for hypofibrinogenemia (odds ratio = 486, P <0.001). We thus hypothesize that fibrinogen synthesis in CRS is up-regulated in an interleukin-6-dependent acute phase reaction compensating for CRS-induced consumption of coagulation factors. Tocilizumab inhibits fibrinogen upregulation resulting in prolonged hypofibrinogenemia. These observations provide novel insights into the pathophysiology of hypofibrinogenemia following CAR T-cell therapy, and emphasize the need for close fibrinogen monitoring after tocilizumab treatment of CRS.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MANAGEMENT; AUTOLEUCEL; BIOMARKERS; GUIDELINES; FIBRINOGEN; DIAGNOSIS; SOCIETY; DISEASE; SCORE; RISK; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II Medicine > Lehrstuhl für Klinische Chemie und Laboratoriumsmedizin |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Jul 2025 12:22 |
| Last Modified: | 22 Jul 2025 12:22 |
| URI: | https://pred.uni-regensburg.de/id/eprint/63465 |
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