Abstract
Background: CART therapy is the most effective method for the treatment of acute lymphoblastic leukemia (ALL) right now, which accompanied with severe cytokine storms (CRS) during treatment, resulting in severe platelet destruction and reduction. So the treatment of platelet transfusion is particularly important to the CART therapy. However, there is no clinical consensus on when given platelet transfusion can patients obtain the maximum benefit.
Methods: In the study, 14 ALL patients were enrolled for the CART treatment. The patients with platelet transfusion refractoriness (PTR) were excluded for non-immune factors such as large spleen and high fever. Blood routine and cytokines such as IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, and IL-17A were monitored during treatment. Body temperature should be less than 38 degrees before transfusion of platelets. Analyze the efficacy of platelet transfusion in patients before the CART treatment, the time with CRS, and after the CRS. The platelet transfusion effect was determined by 24-hour corrected count increment (CCI) (greater than 7.5 considered as effective, otherwise as invalid).
Results: All the patients in the study were treated with platelet transfusion before CART treatment. There was a CSR-3 level in every patients during the treatment. Four of them didn't get platelet transfusion as the lowest platelet count is more than 10×109/L without bleeding tendency. Ten of them received platelet transfusion treatment during CRS and the average of the cytokine were higher than before (IL-2 (12.65±21.08 pg/ml), IL-6 (8540.57±6791.91 pg/ml), IL-10 (1547.46±2939.45 pg/ml), IFN-γ (2846.49±2480.88 pg/ml),P<0.01). The 24 hour CCI of the 10 patients before CART treatment were 10.91±3.27, during CRS were 4.18±4.28, and after CRS were 8.72±2.93 (P<0.01). During the CRS, 24 hour CCI is higher in patients with platelet count below 5×109/L than patients with platelet count between 5-10×109/L(P<0.01).
Conclusion: CRS during CART treatment accelerated platelet consumption, resulting PTR. Platelet transfusion could not be given to patients when they were experiencing the most serious CSR without bleeding tendency, but it can be considered when the platelet count is less than 5×109/L,
Key Words: acute lymphoblastic leukemia, severe cytokine storms, platelet transfusion.
Fig 1: the relationship between 24 hour CCI and the highest IL-6:
The IL-6 is so high that we reduced it by one thousand times in the figure. The 24 hour CCI is negatively correlated with IL - 6, P<0.01, R=-0.92.
No relevant conflicts of interest to declare.
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