Chinese journal of cancer research = Chung-kuo yen cheng yen chiu · 2025
Can one scoring system fit all? Comparative validation of CAR-HEMATOTOX, ALL-HEMATOTOX, and eIPM for predicting immune effector cell-associated hematotoxicity following CAR-T therapy in hematologic malignancies.
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Zhang A, Zheng H, Shang Q, Yin X, Yang Y, Luo Y, Su T, Dou X, Zhao T, Pei X, Liu Z, Lu J, Zhang X, Huang X, Mo X, Lv M, Zhao X
Аннотация
OBJECTIVE: Immune effector cell-associated hematotoxicity (ICAHT), characterized by prolonged cytopenia and delayed hematopoietic recovery, is a common complication following chimeric antigen receptor T (CAR-T) cell therapy. However, the applicability of existing predictive models, CAR-HEMATOTOX (CAR-HT) for lymphoma, acute lymphoblastic leukemia-HEMATOTOX (ALL-HT) for B-ALL, and the early ICAHT prediction model (eIPM), remains uncertain across different hematologic malignancies.
METHODS: We prospectively analyzed 119 patients who received CAR-T therapy between January 2022 and June 2025, including B-ALL (n=62), T-ALL/non-Hodgkin's lymphoma (NHL) (n=25), and multiple myeloma (MM, n=32). The CAR-HT, ALL-HT, and eIPM models were evaluated for their ability to predict ICAHT severity and survival outcomes.
RESULTS: Grade 3 ICAHT occurred in 32.3% of B-ALL, 40.0% of T-ALL/NHL, and 25.0% of MM patients, while grade 4 rates were 33.9%, 20.0%, and 6.3%, respectively. CAR-HT classified 67.2% of patients as high-risk, and ALL-HT identified 56.3% of ALL/NHL patients as high-risk. In both models, high-risk groups experienced significantly more prolonged neutropenia than low-risk groups (CAR-HT: 17.7 vs. 5.3 d, P<0.001; ALL-HT: 21.3 vs. 7.7 d, P<0.001). Both eIPMpre and eIPMpost strongly correlated with grade 3-4 ICAHT (P<0.001). Importantly, survival analysis showed that eIPMpre stratification distinguished outcomes: 1-year overall survival (OS) was 65% in medium+high-risk vs. 84% in low-risk patients (P=0.006), and 1-year disease-free survival (DFS) was 44% vs. 73% (P<0.001). Similar predictive accuracy was observed with eIPMpost.
CONCLUSIONS: The CAR-HT, ALL-HT, and eIPM models consistently identify patients at high risk for severe ICAHT across B-ALL, T-ALL/NHL, and MM. Among these, the eIPM stands out as a promising universal tool for survival prediction. These models provide valuable prognostic insights that can guide supportive care and inform treatment planning in CAR-T therapy.
METHODS: We prospectively analyzed 119 patients who received CAR-T therapy between January 2022 and June 2025, including B-ALL (n=62), T-ALL/non-Hodgkin's lymphoma (NHL) (n=25), and multiple myeloma (MM, n=32). The CAR-HT, ALL-HT, and eIPM models were evaluated for their ability to predict ICAHT severity and survival outcomes.
RESULTS: Grade 3 ICAHT occurred in 32.3% of B-ALL, 40.0% of T-ALL/NHL, and 25.0% of MM patients, while grade 4 rates were 33.9%, 20.0%, and 6.3%, respectively. CAR-HT classified 67.2% of patients as high-risk, and ALL-HT identified 56.3% of ALL/NHL patients as high-risk. In both models, high-risk groups experienced significantly more prolonged neutropenia than low-risk groups (CAR-HT: 17.7 vs. 5.3 d, P<0.001; ALL-HT: 21.3 vs. 7.7 d, P<0.001). Both eIPMpre and eIPMpost strongly correlated with grade 3-4 ICAHT (P<0.001). Importantly, survival analysis showed that eIPMpre stratification distinguished outcomes: 1-year overall survival (OS) was 65% in medium+high-risk vs. 84% in low-risk patients (P=0.006), and 1-year disease-free survival (DFS) was 44% vs. 73% (P<0.001). Similar predictive accuracy was observed with eIPMpost.
CONCLUSIONS: The CAR-HT, ALL-HT, and eIPM models consistently identify patients at high risk for severe ICAHT across B-ALL, T-ALL/NHL, and MM. Among these, the eIPM stands out as a promising universal tool for survival prediction. These models provide valuable prognostic insights that can guide supportive care and inform treatment planning in CAR-T therapy.