Skin-related adverse effects associated with CAR T-cell therapy in blood cancers
Overview
Cutaneous adverse events (AEs) occur in approximately 11% of patients following CAR T-cell therapy for relapsed or refractory B-cell malignancies. These AEs are predominantly low-grade, with maculopapular rash being the most common, and can present early or late after treatment.
Background
CAR T-cell therapy has revolutionized treatment for relapsed or refractory hematologic malignancies such as diffuse large B-cell lymphoma and B-acute lymphoblastic leukemia. While cytokine release syndrome and neurotoxicity are well-characterized toxicities, cutaneous adverse events remain less understood. This study retrospectively evaluated the incidence, types, and timing of skin-related AEs in patients receiving commercial CAR T-cell products.
Cutaneous AEs occurred in 11% of patients post-CAR T-cell therapy, predominantly in those treated for B-cell lymphomas and B-ALL; none were observed in multiple myeloma patients.
Most cutaneous AEs were low-grade (grade 1 or 2), with maculopapular rash being the most frequent manifestation.
The timing of cutaneous AEs varied: 57% early-onset (within 30 days), 22% intermediate (31–180 days), and 22% late-onset (beyond 180 days).
Bullous dermatitis, though rare (9%), was observed and resolved without intervention.
An inverse association was found between the number of prior therapy lines and risk of cutaneous AEs, suggesting immune competence may influence skin toxicity risk.
Topical corticosteroids were used in 30% of affected patients, indicating generally manageable skin toxicity.
Clinical Implications
Clinicians should monitor for cutaneous adverse events following CAR T-cell therapy, as they occur in about one in ten patients and can present early or late post-infusion. Most skin toxicities are low-grade and manageable with topical treatments, but awareness of rare presentations like bullous dermatitis is important. Long-term follow-up is recommended given the potential for delayed skin manifestations.
Conclusion
Cutaneous adverse events are a relatively common and mostly mild complication of CAR T-cell therapy in hematologic malignancies, with variable timing of onset. Recognition and appropriate management can improve patient care during and after CAR T-cell treatment.
References
Pennisi et al. 2023 -- Skin-related adverse effects associated with CAR T-cell therapy in blood cancers
by Elvira Umyarova, John Sharp, Charles Pei, William Pellegrino, Qiuhong Zhao, Nathan Denlinger, Timothy Voorhees, Marcos De Lima, Narendranath Epperla
