13
Table 5. B-cell Aplasia Recommendations
Workup/Evaluation:
• Full blood count
Grading Management
All Grades • Recommend influenza and COVID vaccination of
patients and family members.
• Antiviral and PJP prophylaxis per institutional
standards, for 6–12 months following CAR T-cell
infusion and/or until CD4 cell count is >200 cells/ul.
• Antifungal agents should be considered for high-risk
patients including any patient receiving corticosteroids
for management of CRS or ICANS.
• G-CSF should be considered in patients after CRS
with >7 days of neutropenia.
G1: Asymptomatic, no
intervention needed
• Offer supportive care.
G2: Symptomatic (i.e.
recurrent infections),
non-urgent intervention
indicated
• Consider treatment with intravenous immunoglobulin
(IVIG) replacement therapy at IgG levels <400.
G3: Urgent intervention
indicated
G4: Life-threatening
• Consider treatment with IVIG replacement therapy at
IgG levels <400.
Table 6. Disseminated Intravascular Coagulation (DIC)
Workup/Evaluation:
• Full blood count to assess platelet number, fibrinogen, PT, PTT, d-dimer. A
test scoring system developed by the International Society on Thrombosis and
Haemostasis (ISTH) may be used to help determine if DIC is present. The higher the
score, the more likely it is that DIC is present.
Grading Management
G1: — • Offer supportive care.
G2: Laboratory findings
with no bleeding
• Use IL-6 antagonist with or without corticosteroids.
• If improved to ≤G1, taper steroids over 4–6 weeks.
G3: Laboratory findings
with bleeding
G4: Life-threatening ;
urgent intervention
indicated
• Critical care support.
• Use IL-6 antagonist and methylprednisolone IV 1,000
mg/day for 3 days, followed by rapid taper at 250 mg
every 12 hours for 2 days, 125 mg every 12 hours for 2
days, and 60 mg every 12 hours for 2 days.
• Consider replacement of fibrinogen in patients with a
fibrinogen level below 150 mg/dl.
