What question did this study set out to answer?

To evaluate if pre-lymphodepletion levels of CRP and ferritin can predict early toxicities and hematologic complications post CAR-T therapy.

May 29, 2026

Pre-lymphodepletion CRP and ferritin risk stratification as a predictor of early immune toxicities and hematologic complications after CAR-T therapy: A propensity-matched cohort study.

Key Points

To evaluate if pre-lymphodepletion levels of CRP and ferritin can predict early toxicities and hematologic complications post CAR-T therapy.
Retrospective analysis using TriNetX Network for adults treated with CAR-T.
Patients classified into low, intermediate, and high-risk based on CRP and ferritin levels before lymphodepletion.
Propensity score matching applied to balance demographics and clinical factors.
High-risk patients showed higher odds of cytokine release syndrome (OR 1.56, 95% CI 1.1–2.2; p=0.04) and neurotoxicity (OR 1.86, 95% CI 1.1–3.1; p=0.01).
Those in the high-risk cohort had greater supportive care needs, including increased odds of G-CSF use (OR 2.93, p<0.01) and blood transfusion (OR 2.65, p=0.01).
Severe thrombocytopenia and anemia were more common in high-risk patients (OR 3.59 and OR 2.81, respectively; both p<0.01).

Abstract

7030 Background: Inflammation before CAR-T has been linked to higher rates of immune effector cell-associated toxicities and worse outcomes. A pragmatic pre-lymphodepletion risk stratification using C-reactive protein (CRP) and ferritin has been proposed to identify patients at elevated risk. We used the TriNetX Network to evaluate whether CRP/ferritin risk groups predict clinically relevant early outcomes following CAR-T in a real-world setting. Methods: We performed a retrospective study using TriNetX Network. Adults (≥18 years) treated with CAR-T (day 0) were included if CRP p=0.04) and immune effector cell-associated neurotoxicity syndrome (ICANS) (OR 1.86, 95% CI 1.1–3.1; p=0.01) versus low risk. In intermediate vs low risk, ICANS remained increased (OR 1.69, 95% CI 1.1–2.7; p=0.02), while CRS showed a nonsignificant trend (OR 1.36, 95% CI 0.98–1.9; p=0.06). High risk cohort was associated with greater supportive care utilization, including higher odds of G-CSF use (OR 2.93, 95% CI 1.5–5.8; p<0.01) and blood transfusion (OR 2.65, 95% CI 1.2–5.9; p=0.01) versus low risk. High vs low-risk was associated with higher odds of platelets <50 (OR 3.59, 95% CI 1.98–6.5; p<0.01) and hemoglobin <8 (OR 2.81, 95% CI 1.3–5.9; p<0.01). Neutropenia (ANC <500) was not significantly different. In intermediate vs low risk, cytopenia-related endpoints were not significantly different. All-cause mortality analysis was not performed due to low event rates. Conclusions: In a TriNetX propensity-matched real-world cohort, a simple pre-lymphodepletion CRP and ferritin stratification identified CAR-T recipients at significantly higher risk for early immune toxicities (CRS, ICANS) and clinically meaningful hematotoxicities (severe thrombocytopenia and anemia) within 30 days, along with increased need for G-CSF & transfusion support. These findings support using simple pre-infusion inflammatory biomarkers to guide counseling, risk-adapted monitoring, and proactive supportive care strategies in routine practice.

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Pre-lymphodepletion CRP and ferritin risk stratification as a predictor of early immune toxicities and hematologic complications after CAR-T therapy: A propensity-matched cohort study.

Key Points

Abstract

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