The following article features coverage from the American Society of Hematology 2020 meeting. Click here to read more of MPR’s conference coverage.


Hypogammaglobulinemia occurred in most patients with chronic lymphocytic leukemia (CLL) who received CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy, but its management with intravenous immunoglobulins (IVIG) lacked standardization, according to the results of a pooled analysis. The results were reported at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.

The pooled analysis included 67adult patients with CLL who were treated with CD19-directed CAR T cells in 1 of 3 clinical trials (ClinicalTrials.gov Identifier: NCT01029366, ClinicalTrials.gov Identifier: NCT01747486, and ClinicalTrials.gov Identifier: NCT02640209).

Overall, 44% of patients had hypogammaglobulinemia before CAR-T infusion, and 81% developed new or persistent hypogammaglobulinemia after CAR-T infusion. IVIG was available for treatment of hypogammaglobulinemia, and 72% of patients received at least 1 infusion after CAR-T infusion. Overall, 83% of patients who achieved a response and 59% who did not achieve a response received IVIG.


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Infections were more common in patients who achieved a response compared with those who did not (P =.01). Infections were also more common in patients who had hypogammaglobulinemia after CAR-T infusion compared with those who did not (1.74 vs 1). Receipt of IVIG was associated with more infections (P =.003)

Lead author of the poster, Natalie Uy, MD, Hospital Medicine/Department of Medicine, University of Pennsylvania, said the use of IVIG was driven by individual practice. “There’s a lot of heterogeneity on when people got it, how [frequently] they got it, and how long they got it.” The characteristics of patients who had hypogammaglobulinemia after CAR-T infusion were not significantly different from patients who did, even for survival outcomes.

“Further studies to define criteria for IVIG repletion in CLL patients treated with CAR-T could be incorporated in a standard clinical management algorithm to add some standardization to this practice,” said Dr Uy.

Disclosures: Some of the presenters disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the presentation abstract.

Read more of MPR’s coverage of the ASH 2020 meeting by visiting the conference page.

Reference

Uy NF, Pequignot E, Frey NV, et al. Hypogammaglobulinemia and infection risk in chronic lymphocytic leukemia (CLL) patients treated with CD19-directed chimeric antigen receptor T (CAR-T) cells. Poster at: the 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; December 5-8, 2020. Abstract 2224.

This article originally appeared on Cancer Therapy Advisor