Skip to main content

Nutritional status alterations after chimeric antigen receptor T cell therapy in patients with hematological malignancies: a retrospective study

Abstract

Purpose

The influence of innovative chimeric antigen receptor T cell (CAR-T) therapy for hematological malignancies on nutritional status remains unknown. Therefore, we aim to explore the alterations of nutritional status after CAR-T cell therapy in patients with hematological malignancies.

Methods

We retrospectively collected the data of patients with acute leukemia (AL), lymphoma, and multiple myeloma (MM), who underwent CAR-T therapy at our hospital from 2018 to 2020. The serum albumin, triglyceride, and cholesterol before and 7, 14, and 21 days after CAR-T cell infusion were compared and analyzed.

Result

A total of 117 patients were enrolled, consisting of 39 AL, 23 lymphoma, and 55 MM patients. The baseline albumin, triglyceride, and cholesterol were 37.43 ± 5.08 mg/L, 1.63 ± 0.74 mmol/L, and 3.62 ± 1.03 mmol/L, respectively. The lowest albumin level was found at 7 days after CAR-T cell infusion compared with baseline (P < 0.001), while the levels of triglyceride increased at 14 and 21 days (P < 0.001, P = 0.036). The levels of cholesterol at 7, 14, and 21 days after CAR-T cell infusion were lower than baseline (all P < 0.05). Spearman’s correlation coefficient showed cytokine release syndrome grade was negatively correlated with the levels of albumin at 7 days and cholesterol at 21 days after CAR-T cell infusion (r =  − 0.353, P < 0.001; r =  − 0.395, P = 0.002).

Conclusion

The alterations of different nutrition-related biochemical parameters varied after CAR-T cell therapy. The levels of albumin and total cholesterol after CAR-T cell infusion were negatively correlated with the grade of cytokine release syndrome. Specific screening and intervention for malnutrition in patients receiving CAR-T cell therapy need to be explored in further studies.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Availability of data and material

Data is available on request.

Code availability

Not applicable.

References

  1. Mullard A (2017) FDA approves first CAR T therapy. Nature Reviews Drug Discovery 16(10):669–669. https://doi.org/10.1038/nrd.2017.196

    CAS  Article  PubMed  Google Scholar 

  2. Mullard A (2017) Second anticancer CAR T therapy receives FDA approval. Nature Reviews Drug Discovery 16(12):818–818. https://doi.org/10.1038/nrd.2017.249

    CAS  Article  PubMed  Google Scholar 

  3. Ma S et al (2019) Current progress in CAR-T cell therapy for solid tumors. Int J Biol Sci 15(12):2548–2560

    CAS  Article  Google Scholar 

  4. Lin WY et al (2020) Gene modified CAR-T cellular therapy for hematologic malignancies. Int J Mol Sci 21(22):8655

    CAS  Article  Google Scholar 

  5. Park JH et al (2018) Long-term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia. N Engl J Med 378(5):449–459

    CAS  Article  Google Scholar 

  6. Brudno JN, Kochenderfer JN (2019) Recent advances in CAR T-cell toxicity: mechanisms, manifestations and management. Blood Rev 34:45–55

    CAS  Article  Google Scholar 

  7. Neelapu SS et al (2018) Chimeric antigen receptor T-cell therapy - assessment and management of toxicities. Nat Rev Clin Oncol 15(1):47–62

    CAS  Article  Google Scholar 

  8. Skorka K et al (2020) The application of CAR-T cells in haematological malignancies. Arch Immunol Ther Exp (Warsz) 68(6):34

    CAS  Article  Google Scholar 

  9. La Torre M et al (2013) Malnutrition and pancreatic surgery: prevalence and outcomes. J Surg Oncol 107(7):702–708

    Article  Google Scholar 

  10. Lemos Pdos S, de Oliveira FL, Caran EM (2014) Nutritional status of children and adolescents at diagnosis of hematological and solid malignancies. Rev Bras Hematol Hemoter 36(6):420–3

    Article  Google Scholar 

  11. von Meyenfeldt M (2005) Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs 9(Suppl 2):S35–S38

    Article  Google Scholar 

  12. Mondello P et al (2014) Emerging markers of cachexia predict survival in cancer patients. BMC Cancer 14:828

    Article  Google Scholar 

  13. Fearon KC, Glass DJ, Guttridge DC (2012) Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab 16(2):153–166

    CAS  Article  Google Scholar 

  14. Xia LJ et al (2020) Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1–2 rectal cancer. BMC Cancer 20(1):208

    CAS  Article  Google Scholar 

  15. Jager-Wittenaar H, Ottery FD (2017) Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care 20(5):322–329

    Article  Google Scholar 

  16. Cessot A et al (2011) Defining the clinical condition of cancer patients: it is time to switch from performance status to nutritional status. Support Care Cancer 19(7):869–870

    Article  Google Scholar 

  17. Co-Reyes E et al (2012) Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions. Pediatr Blood Cancer 59(7):1160–1167

    Article  Google Scholar 

  18. Lange BJ et al (2005) Mortality in overweight and underweight children with acute myeloid leukemia. JAMA 293(2):203–211

    CAS  Article  Google Scholar 

  19. Suzuki H et al (2013) Cancer cachexia–pathophysiology and management. J Gastroenterol 48(5):574–594

    CAS  Article  Google Scholar 

  20. Planas M et al (2016) Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES(R) study. Support Care Cancer 24(1):429–435

    Article  Google Scholar 

  21. Sanford DE et al (2014) Severe nutritional risk predicts decreased long-term survival in geriatric patients undergoing pancreaticoduodenectomy for benign disease. J Am Coll Surg 219(6):1149–1156

    Article  Google Scholar 

  22. Saucillo DC et al (2014) Leptin metabolically licenses T cells for activation to link nutrition and immunity. J Immunol 192(1):136–144

    CAS  Article  Google Scholar 

  23. Wensveen FM et al (2015) Interactions between adipose tissue and the immune system in health and malnutrition. Semin Immunol 27(5):322–333

    CAS  Article  Google Scholar 

  24. Hu Y et al (2017) Potent anti-leukemia activities of chimeric antigen receptor–modified T cells against CD19 in Chinese patients with relapsed/refractory acute lymphocytic leukemia. Clin Cancer Res 23(13):3297–3306

    CAS  Article  Google Scholar 

  25. Porter DL et al (2015) Chimeric antigen receptor T cells persist and induce sustained remissions in relapsed refractory chronic lymphocytic leukemia. Science Translational Medicine 7(303):303ra139-303ra139

    Article  Google Scholar 

  26. Porter DL et al (2011) Chimeric antigen receptor-modified T cells in chronic lymphoid leukemia. N Engl J Med 365(8):725–733

    CAS  Article  Google Scholar 

  27. McLean TW et al (2020) Hypoalbuminemia in children with cancer treated with chemotherapy. Pediatr Blood Cancer 67(2):e28065

    Article  Google Scholar 

  28. Yilmaz M et al (2020) The effect of malnutrition on mortality in hospitalized patients with hematologic malignancy. Support Care Cancer 28(3):1441–1448

    Article  Google Scholar 

  29. Tandon S et al (2015) Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia. Indian Pediatr 52(5):385–389

    Article  Google Scholar 

  30. Marini A et al (1989) Serum cholesterol and triglycerides in hematological malignancies. Acta Haematol 81(2):75–79

    CAS  Article  Google Scholar 

  31. Jiang Y et al (2020) Nutrition and metabolism status alteration in advanced hepatocellular carcinoma patients treated with anti-PD-1 immunotherapy. Support Care Cancer 28(11):5569–5579

    Article  Google Scholar 

  32. Idogun SE, Omoti CE (2011) Effects of chemotherapy on plasma lipids and lipoproteins in Nigerian patients with haematological malignancy. Niger Postgrad Med J 18(1):16–19

    CAS  PubMed  Google Scholar 

  33. Kuliszkiewicz-Janus M, Malecki R, Mohamed AS (2008) Lipid changes occuring in the course of hematological cancers. Cell Mol Biol Lett 13(3):465–474

    CAS  Article  Google Scholar 

  34. Alwarawrah Y, Kiernan K, MacIver NJ (2018) Changes in nutritional status impact immune cell metabolism and function. Front Immunol 9:1055

    Article  Google Scholar 

  35. Argiles JM, Busquets S, Lopez-Soriano FJ (2003) Cytokines in the pathogenesis of cancer cachexia. Curr Opin Clin Nutr Metab Care 6(4):401–406

    CAS  PubMed  Google Scholar 

  36. Shimabukuro-Vornhagen A et al (2018) Cytokine release syndrome. J Immunother Cancer 6(1):56

    Article  Google Scholar 

  37. Najera O et al (2004) Flow cytometry study of lymphocyte subsets in malnourished and well-nourished children with bacterial infections. Clin Diagn Lab Immunol 11(3):577–580

    PubMed  PubMed Central  Google Scholar 

  38. Elmoamly S, Afif A (2018) Can biomarkers of coagulation, platelet activation, and inflammation predict mortality in patients with hematological malignancies? Hematology 23(2):89–95

    CAS  Article  Google Scholar 

  39. Kharfan-Dabaja MA et al (2018) Hypoalbuminaemia segregates different prognostic subgroups within the refined standard risk acute graft-versus-host disease score. Br J Haematol 180(6):854–862

    CAS  Article  Google Scholar 

Download references

Funding

This work was supported by the Medical Science and Technology Project of Zhejiang Provincial Health Commission (grant no. 2021432523) and Department of Education of Zhejiang Province (grant no. Y202043556).

Author information

Authors and Affiliations

Authors

Contributions

Shuyi Ding, Lingxia Cai, Aiyun Jin, Xiaoyu Zhou, Jiali Yan, and Tingting Wang designed the study and collected the data. Linqin Wang and Houli Zhao analyzed the data and wrote the manuscript. Yongxian Hu proofread the manuscript.

Corresponding author

Correspondence to Yongxian Hu.

Ethics declarations

Ethics approval

These clinical trials were performed according to the ethical principles of the Declaration of Helsinki. Approval was granted by the Medical Ethics Committee of the First Affiliated Hospital of Medical College, Zhejiang University (ChiCTR-ORN-16008948, ChiCTR1800015575, ChiCTR-OIC-17011310, ChiCTR1800017404).

Consent for publication

Obtained.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ding, S., Cai, L., Jin, A. et al. Nutritional status alterations after chimeric antigen receptor T cell therapy in patients with hematological malignancies: a retrospective study. Support Care Cancer 30, 3321–3327 (2022). https://doi.org/10.1007/s00520-021-06639-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06639-2

Keywords

  • Nutritional status
  • CAR-T therapy
  • Hematological malignancies
  • Cytokine release syndrome