Clinical Scorecard: Skin-related adverse effects associated with CAR T-cell therapy in blood cancers

At a Glance

Key Highlights

• Cutaneous adverse events (AEs) occurred in approximately 11% of patients post CAR T-cell therapy, mostly low-grade (grade 1 or 2).
• Most common cutaneous AEs were maculopapular rash, pruritic macular rash, and bullous dermatitis.
• Cutaneous AEs onset varied: 57% early (within 30 days), 22% intermediate (31–180 days), and 22% late (>180 days), indicating diverse immune mechanisms.

Guideline-Based Recommendations

Diagnosis

• Systematic assessment of cutaneous AEs using clinical documentation, dermatology consultation, and skin biopsy when indicated.
• Classification of cutaneous AEs by likelihood of association with CAR T-cell therapy and grading per CTCAE v5.0.

Management

• Most cutaneous AEs are low-grade and may be managed conservatively.
• Topical corticosteroids (e.g., hydrocortisone, triamcinolone) and topical antibiotics can be used as needed.
• Dermatologic consultation recommended for diagnostic confirmation and management guidance.

Monitoring & Follow-up

• Long-term follow-up is essential due to potential for late-onset cutaneous AEs beyond 180 days post-infusion.
• Monitor for multiple or recurrent cutaneous AEs even after resolution of systemic toxicities and disease progression.

Risks

• Patients with fewer prior lines of therapy may have higher risk of cutaneous AEs, possibly due to greater immune competence.
• Bullous dermatitis, though rare, represents a potentially significant immune-mediated cutaneous toxicity.

Patient & Prescribing Data

246 patients treated with commercial CAR T-cell products for relapsed/refractory B-cell lymphomas, B-ALL, and multiple myeloma

Cutaneous AEs occurred only in patients treated for B-cell lymphomas and B-ALL; none observed in multiple myeloma patients in this cohort. Incidence aligns with registrational trial data (8-31%).

Clinical Best Practices

• Perform thorough dermatologic evaluation for any new skin findings post CAR T-cell therapy.
• Grade cutaneous AEs using standardized criteria (CTCAE v5.0) to guide management.
• Consider timing of onset to differentiate immune mechanisms and tailor monitoring.
• Use topical corticosteroids as first-line treatment for low-grade cutaneous AEs.
• Maintain vigilance for rare but serious manifestations such as bullous dermatitis.
• Ensure multidisciplinary collaboration between oncology and dermatology for optimal patient care.

References

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