Predicting infection risk following CAR-T using the bedside CAR-HEMATOTOX score: performance in an Australian cohort

Reynolds, Gemma K; Dowling, Mark R; Vogrin, Sara; Smibert, Olivia C; Teh, Benjamin W; Anderson, Mary Ann; Thursky, Karin; Harrison, Simon J; Slavin, Monica A

Author(s): Reynolds, Gemma K; Dowling, Mark R; Vogrin, Sara; Smibert, Olivia C; Teh, Benjamin W; Anderson, Mary Ann; Thursky, Karin; Harrison, Simon J; Slavin, Monica A;
Details: Publication Year 2025-11-11,Volume 1,Issue #3,Page 100020
Journal Title: Blood Immunol Cell Therapy
Abstract: The CAR-HEMATOTOX (HT) score predicts prolonged neutropenia after chimeric antigen receptor T-cell (CAR-T) therapy. Patients with aggressive lymphoma with HT scores ≥2 (HThigh) have experienced higher rates of severe infections compared to patients with lower scores (HTlow). We aimed to validate HT’s prediction capability in an independent aggressive lymphoma cohort, treated with standard-of-care CAR-T, between January 2019 and September 2023. HT scores were calculated according to original methods. Infections were defined as microbiologically-confirmed or clinically-diagnosed. Severe infections were classified as CTCAE (Common Terminology Criteria for Adverse Events) grade ≥3. Logistic regression evaluated HT’s association with infections within 90 days, and separately for early (day 0-30) and late (day 30-90) infections. Model fit was evaluated by area under the curve (AUC). Among 109 patients, infections occurred in 31 patients (54% grade ≥3). HThigh status was not associated with any-grade infections across day 0 to 90 (odds ratio [OR], 1.91; 95% confidence interval [CI], 0.82-4.42; P = .13), but was significantly associated with severe infections (OR, 8.67; 95% CI, 2.30-32.68; P = .001), with very good discriminative validity (AUC, 0.74). HThigh status performed as a better predictor for late severe infections (AUC, 0.85), compared with early severe infections (AUC, 0.62). Multivariate logistic regression also identified tocilizumab (OR, 1.52; 95% CI, 1.02-2.38; P = .041), prolonged neutropenia (OR, 11.95; 95% CI, 1.64-210.75; P = .001), and prolonged steroid (OR, 38.58; 95% CI, 2.05-725.91; P < .01) as significantly associated with infection. The relationship between HThigh and risk of severe infection was validated in our large B-cell lymphoma cohort. HThigh was an excellent discriminative predictor of late severe infections.
Publisher: Elsevier
Research Division(s): Blood Cells and Blood Cancer
Publisher's Version: https://doi.org/10.1016/j.bict.2025.100020
Open Access at Publisher's Site: https://doi.org/10.1016/j.bict.2025.100020
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-01-22 10:03:37

Last Modified: 2026-01-22 10:03:53