HemaSphere Podcast EHA/EBMT Survey on Grading and Management of ICAHT - Dr Kai Rejeski
Oct 1, 2025
Dr Kai Rejeski, hematologist researching CAR-T toxicities, discusses prolonged cytopenias after CAR-T and why they were underappreciated. He describes running a 72-center, 18-country survey, debates early GCSF use and stem cell boosts for severe neutropenia. He also talks about creating a practical ICAT grading framework and priorities for future CAR-T research.
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CAR T Toxicities Shift From Acute To Long Term
- CAR T toxicities evolved from novel acute syndromes to long-term hematologic issues that need distinct attention.
- Kai Rejeski highlights CRS and ICANS as early novel syndromes while prolonged cytopenias and infections emerged later as major morbidity drivers.
Why Cytopenias Were Overlooked Early On
- Hematological toxicity was initially underappreciated because it was attributed to lymphodepleting chemotherapy and not seen as novel.
- Rejeski notes cytopenias were frequent and protracted, with many patients showing neutropenia beyond day 21 in lymphoma cohorts.
Use Prospective Data Not Just Clinical Gestalt
- Base practice changes on objective evidence and pursue prospective trials rather than relying solely on clinical gestalt.
- Rejeski urges prospective studies for G-CSF timing because retrospective data are confounded by indication bias.