{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:44:35Z","timestamp":1789577075708,"version":"build-2803163510"},"reference-count":27,"publisher":"SAABRON PRESS","issue":"1","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of lymphoid malignancies. Prolonged cytopenias, though poorly understood, have emerged as important considerations in the treatment process. In this review, we classified cytopenias into early (&lt; 30 days post CAR T infusion), and late-occurring (after day 30 post infusion). We identified previous chemotherapy and lymphodepletion chemotherapy as the major risk factors contributing to early cytopenia. Product characteristics, such as costimulatory domains, and side effects of therapy such as cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) were identified as contributing factors to prolonged cytopenias occurring more than 30 days post CAR-T infusion. We recommend close monitoring with frequent checks, enhanced care with granulocyte colony stimulating factor (GCSF) support for grade 3-4 neutropenia, blood transfusion for severe anemia (Hb &lt; 7g\/dL), platelets for severe thrombocytopenia (&lt; 10,000\/\u00b5L) and thrombopoietin (TPO) mimetics such as eltrombopag or romiplostim for prolonged severe thrombocytopenia in patients at high-risk of hemorrhagic complications.<\/jats:p>","DOI":"10.46989\/001c.126463","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T16:02:22Z","timestamp":1743004942000},"source":"Crossref","is-referenced-by-count":14,"title":["Prolonged Cytopenia with CAR-T Cell Therapy and Management Recommendations"],"prefix":"10.46989","volume":"7","author":[{"given":"Debolanle","family":"Dahunsi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05e94g991","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Illinois System","department":["College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Eleanya","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02t771148","id-type":"ROR","asserted-by":"publisher"}],"name":"National Cancer Institute","department":["Center for Immuno-Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akintomiwa","family":"Akintunde","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00k63dq23","id-type":"ROR","asserted-by":"publisher"}],"name":"Meharry Medical College","department":["Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olalekan","family":"Oluwole","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05dq2gs74","id-type":"ROR","asserted-by":"publisher"}],"name":"Vanderbilt University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26435","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1038\/s41409-022-01771-x","article-title":"Management of prolonged cytopenia following CAR T-cell therapy","volume":"57","author":"M. Corona","year":"2022","journal-title":"Bone marrow transplantation"},{"issue":"5","key":"ref2","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/S1470-2045(06)70664-7","article-title":"CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group","volume":"7","author":"M. Pfreundschuh","year":"2006","journal-title":"The Lancet Oncology"},{"issue":"4","key":"ref3","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1056\/NEJMoa011795","article-title":"CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma","volume":"346","author":"B. Coiffier","year":"2002","journal-title":"The New England journal of medicine"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-024-02274-y","article-title":"Dynamics of clonal hematopoiesis under DNA-damaging treatment in patients with ovarian cancer","author":"C. M. Arends","year":"2024","journal-title":"Leukemia"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24712","article-title":"Association of PARP inhibitor treatment on the prevalence and progression of clonal hematopoiesis in patients with advanced prostate cancer","author":"C. H. Marshall","year":"2024","journal-title":"Prostate"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"Jco2302547","DOI":"10.1200\/JCO.23.02547","article-title":"Clonal Hematopoiesis and Therapy-Related Myeloid Neoplasms After Autologous Transplant for Hodgkin Lymphoma","volume":"2024","author":"C. Yan","journal-title":"Journal of clinical oncology: official journal of the American Society of Clinical Oncology"},{"issue":"19","key":"ref7","doi-asserted-by":"publisher","first-page":"4898","DOI":"10.1182\/bloodadvances.2020002394","article-title":"Tumor burden, inflammation, and product attributes determine outcomes of axicabtagene ciloleucel in large B-cell lymphoma","volume":"4","author":"F. L. Locke","year":"2020","journal-title":"Blood Adv"},{"issue":"24","key":"ref8","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1182\/blood.2020010543","article-title":"CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed\/refractory large B-cell lymphoma","volume":"138","author":"K. Rejeski","year":"2021","journal-title":"Blood"},{"issue":"3","key":"ref9","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.annonc.2021.12.003","article-title":"Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA)","volume":"33","author":"P. J. Hayden","year":"2022","journal-title":"Annals of Oncology"},{"issue":"2","key":"ref10","doi-asserted-by":"publisher","first-page":"297","DOI":"10.3324\/haematol.2019.229781","article-title":"Management of adults and children undergoing chimeric antigen receptor T-cell therapy: best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE)","volume":"105","author":"I. Yakoub-Agha","year":"2020","journal-title":"Haematologica"},{"issue":"26","key":"ref11","doi-asserted-by":"publisher","first-page":"2531","DOI":"10.1056\/NEJMoa1707447","article-title":"Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma","volume":"377","author":"S. S. Neelapu","year":"2017","journal-title":"The New England journal of medicine"},{"issue":"12","key":"ref12","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1038\/s41409-020-01006-x","article-title":"G-CSF does not worsen toxicities and efficacy of CAR-T cells in refractory\/relapsed B-cell lymphoma","volume":"55","author":"E. Galli","year":"2020","journal-title":"Bone Marrow Transplant"},{"issue":"5 Suppl","key":"ref13","first-page":"Ecr08","article-title":"Spontaneous splenic rupture in a healthy allogeneic donor of peripheral-blood stem cell following the administration of granulocyte colony-stimulating factor (g-csf). A case report and review of the literature","volume":"91","author":"N. M. Nuamah","year":"2006","journal-title":"Haematologica"},{"issue":"1","key":"ref14","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/1757-1626-1-418","article-title":"Splenic rupture, secondary to G-CSF use for chemotherapy induced neutropenia: a case report and review of literature","volume":"1","author":"N. Masood","year":"2008","journal-title":"Cases J"},{"issue":"Supplement 1","key":"ref15","doi-asserted-by":"publisher","first-page":"12757","DOI":"10.1182\/blood-2022-162433","article-title":"Eltrombopag Stimulation for Neutrophil and Platelet Recovery Following Axicabtagene Ciloleucel (axi-cel) Therapy in Lymphoma","volume":"140","author":"W. Wesson","year":"2022","journal-title":"Blood"},{"issue":"6","key":"ref16","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1080\/14737140.2024.2344650","article-title":"How to manage prolonged immune effector cell-associated hematotoxicity (ICAHT) related to BCMA-directed myeloma therapy","volume":"24","author":"J. A. Davis","year":"2024","journal-title":"Expert Rev Anticancer Ther"},{"issue":"9","key":"ref17","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.jtct.2023.05.012","article-title":"Efficacy and Safety of CD34+ Stem Cell Boost for Delayed Hematopoietic Recovery After BCMA Directed CAR T-cell Therapy","volume":"29","author":"J. A. Davis","year":"2023","journal-title":"Transplant Cell Ther"},{"issue":"8","key":"ref18","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1182\/bloodadvances.2023011767","article-title":"Applying the EHA\/EBMT grading for ICAHT after CAR-T: comparative incidence and association with infections and mortality","volume":"8","author":"K. Rejeski","year":"2024","journal-title":"Blood Adv"},{"issue":"6","key":"ref19","doi-asserted-by":"publisher","first-page":"e459","DOI":"10.1016\/S2352-3026(24)00077-2","article-title":"Immune effector cell-associated haematotoxicity after CAR T-cell therapy: from mechanism to management","volume":"11","author":"K. Rejeski","year":"2024","journal-title":"Lancet Haematol"},{"issue":"36","key":"ref20","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.36.15_suppl.7505","article-title":"Updated safety and long term clinical outcomes in TRANSCEND NHL 001, pivotal trial of lisocabtagene maraleucel (JCAR017) in R\/R aggressive NHL","volume":"36","author":"Jeremy S. Abramson","year":"2018","journal-title":"ASCO 2018"},{"key":"ref21","article-title":"Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma","author":"S. J. Schuster","year":"2018","journal-title":"The New England journal of medicine"},{"issue":"7","key":"ref22","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1056\/NEJMoa2116133","article-title":"Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma","volume":"386","author":"F. L. Locke","year":"2022","journal-title":"The New England journal of medicine"},{"issue":"6","key":"ref23","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1189\/jlb.5BT1115-524R","article-title":"At The Bedside: Clinical review of chimeric antigen receptor (CAR) T cell therapy for B cell malignancies","volume":"100","author":"O.O. Oluwole","year":"2016","journal-title":"Journal of leukocyte biology"},{"issue":"20","key":"ref24","doi-asserted-by":"publisher","first-page":"2460","DOI":"10.1182\/blood.2022017415","article-title":"How I treat cytopenias after CAR T-cell therapy","volume":"141","author":"T. Jain","year":"2023","journal-title":"Blood"},{"issue":"6","key":"ref25","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14061501","article-title":"Cytopenia after CAR-T Cell Therapy-A Brief Review of a Complex Problem","volume":"14","author":"N. Sharma","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"Suppl 1","key":"ref26","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/jha2.350","article-title":"CAR-T-OPENIA: Chimeric antigen receptor T-cell therapy-associated cytopenias","volume":"3","author":"A. Taneja","year":"2022","journal-title":"EJHaem"},{"issue":"10343","key":"ref27","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1016\/S0140-6736(22)00662-6","article-title":"Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial","volume":"399","author":"M. Kamdar","year":"2022","journal-title":"Lancet (London, England)"}],"container-title":["Clinical Hematology International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/chi.scholasticahq.com\/article\/126463-prolonged-cytopenia-with-car-t-cell-therapy-and-management-recommendations","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T16:02:33Z","timestamp":1743004953000},"score":1,"resource":{"primary":{"URL":"https:\/\/chi.scholasticahq.com\/article\/126463-prolonged-cytopenia-with-car-t-cell-therapy-and-management-recommendations"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.46989\/001c.126463","relation":{},"ISSN":["2590-0048"],"issn-type":[{"value":"2590-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]}}}