Thrombopoietin (TPO) receptor agonists can produce responses in patients with severe persistent cytopenia associated with anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, according to findings published in the Annals of Hematology.

In this study, 93 patients with diffuse large B-cell lymphoma (DLBCL) were evaluated for persistent cytopenia 21 to 28 days after CAR-T infusion at the Tel Aviv Sourasky Medical Center between 2019 and 2021.

Patients with severe persistent cytopenia, defined as absolute neutrophil count (ANC) less than 500/mL and/or platelet count (PLT) less than 20,000/mL, were given TPO receptor agonists.

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There were 4 patients who had prolonged severe cytopenia after receiving tisagenlecleucel and 2 who had prolonged severe cytopenia after axicabtagene.

Five of the 6 patients developed neutropenia by day 6 after CAR-T infusion. Four patients had neutrophil recovery followed by a secondary neutropenia event occurring between days 10 and 30.

The patients received TPO receptor agonist therapy a median of 43 days (range, 21-55) after CAR-T infusion. Four patients received eltrombopag, 1 patient received romiplostim, and 1 patient started on romiplostim and was switched to eltrombopag.

All 6 patients responded to treatment, and 5 patients had complete resolution of all blood counts. The median time to resolution was 27 days (range, 6-38) for PLT and 29 days (range, 7-61) for ANC. No relapses were observed.

One patient had a grade 1 increase in liver enzymes at 10 days, which resolved after 3 days of withholding therapy. No other toxicity events occurred.

This study was limited by its small sample size.

The study authors concluded that additional research into the efficacy and safety of TPO receptor agonist treatment for CAR T-associated severe prolonged neutropenia in DLBCL is warranted.


Beyar-Katz O, Perry C, On YB, et al. Thrombopoietin receptor agonist for treating bone marrow aplasia following anti‑CD19 CAR‑T cells—single‑center experience. Ann Hematol. 2022;101:1769-1776. doi:10.1007/s00277-022-04889-6

This article originally appeared on Oncology Nurse Advisor