ETD

• car-t
• coagulopathy
• dic
• hemorrhagic and thrombotic risk.

The study retrospectively analyzed the incidence, risk factors, and clinical impact of coagulopathies, particularly disseminated intravascular coagulation (DIC), in patients with lymphoproliferative disorders treated with CAR-T cell therapy. It was found that CAR-T–associated coagulopathy represents a relatively uncommon but clinically significant toxicity, with an incidence of overt DIC of 5.5%.

The most relevant hemostatic abnormalities involved prothrombin time, fibrinogen, antithrombin III, platelet count, and hemoglobin, indicating a transient hemostatic dysfunction related to the systemic inflammatory response following CAR-T infusion.

Univariate analysis identified several predictive factors for overt DIC: younger age, diagnosis of B-cell acute lymphoblastic leukemia, presence of bulky disease, higher CAR-HEMATOTOX score, and shorter vein-to-vein times. In the post-infusion phase, DIC occurrence was associated with higher-grade cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), higher interleukin-6 peaks, and greater CAR-T cell expansion. These findings suggest a central role of endothelial dysfunction induced by hyperinflammation.

The use of tocilizumab did not reach statistical significance, although a trend was observed toward an association between a higher number of administrations and an increased risk of inflammatory and neurological toxicities.

Future directions should focus on integrated prevention strategies combining early control of inflammation, particularly CRS, with endothelial-protective interventions.