Toxicity From CD19, BCMA Therapy May Inform B-Cell Malignancy Surveillance

CD19- and BCMA-targeting CAR-T cell therapies displayed distinct adverse effect (AE) patterns, specifically for neurologic and cardiovascular effects, which may help tailor nursing actions and surveillance, according to findings from a literature review presented at the 51st Annual Oncology Nursing Society (ONS) Congress.

Main Data

The data driving the findings of this systematic review came from the extraction of safety timelines and complication frequencies across 26 eligible published articles. Although the analysis focused entirely on safety profiles rather than direct clinical tumor responses, the primary data outcomes successfully mapped distinct, target-specific toxicities across critical chronological boundaries from day 0 to beyond day 90.

The data demonstrated that both anti-CD19 and anti-BCMA CAR T-cell therapies carry a shared, prolonged risk for infections and cytopenias that persists from the day of infusion through day 90 and beyond. However, a major divergence in the data revealed that neurological and cardiovascular risks are highly dependent on class; major adverse cardiovascular events (MACE) were uniquely localized to CD19-targeting therapies within the first 15 days, whereas late onset manifestations like parkinsonism and cranial nerve palsies were uniquely documented in patients receiving BCMA-targeting therapies.

“CD19- and BCMA-targeting CAR-T therapies demonstrate distinct AE patterns, particularly for neurologic and cardiovascular events,” presenting author Helene Coignet, BSN, RN, OCN, CCRC, a hemato-oncology registered nurse and associate director of CAR-T at Johnson & Johnson Innovative Medicine, wrote in the presentation with study coinvestigators. “Nurses should anticipate timing windows for specific AEs to enable early recognition and targeted interventions…These findings reinforce the need for early monitoring for hypersensitivity and CRS.”

Trial Details

This study was designed as a comprehensive literature review and informal data synthesis rather than a single, standalone clinical trial. To gather the data, the investigators formulated a strict search strategy utilizing keywords and Medical Subject Headings focused on approved anti-CD19 and anti-BCMA therapies. They searched major biomedical databases, including PubMed, Scopus, and Google Scholar, and restricted their scope to articles published from 2022 to 2025. The methodology mandated an initial screening of all identified papers based on titles and abstracts, followed by an exhaustive full-text review to confirm eligibility. Ultimately, 26 articles met all inclusion criteria and were selected for final data extraction to synthesize the comprehensive timeline of acute and late onset AEs.

Patient Characteristics

The patient populations represented across the pooled literature included adult patients diagnosed with relapsed/refractory hematologic malignancies who had received approved CAR-T products. The specific diagnostic subgroups evaluated within the anti-CD19 cohort consisted of patients with B-cell leukemias and lymphomas, while the anti-BCMA cohort comprised patients with multiple myeloma. While individual baseline demographics, median ages, and specific gender ratios were not independent variables explicitly detailed within this macro-level poster synthesis, all analyzed data strictly reflected adult patient populations undergoing active clinical management with these specific cellular therapies.

Main Objectives

The primary objectives of this safety analysis were to comprehensively describe, categorize, and compare the precise incidence, onset, and duration of reported AEs following treatment with either CD19- or BCMA-directed therapies. The investigators sought to organize these toxicities into practical clinical timeframes, specifically evaluating complications occurring from 0 to 15 days, 0 to 30 days, and greater than 90 days after infusion. By synthesizing these chronological endpoints into a unified visual profile, the study aimed to establish a standard timeline that multidisciplinary oncology teams can use to govern post-infusion monitoring frequency, structure patient discharge counseling, and refine institutional clinical escalation protocols.

Safety

Safety outcomes demonstrated highly distinct temporal patterns and toxicities between the 2 target-specific CAR-T classes. Within the acute 0-to-15-day post-infusion window, infusion-day hypersensitivity reactions were common to all evaluated CAR-T products. Similarly, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) occurred across both classes during this initial 2-week period. For patients receiving anti-CD19 therapies, including tisagenlecleucel (Kymriah), axicabtagene ciloleucel (Yescarta; axi-cel), lisocabtagene maraleucel (Breyanzi; liso-cel), and brexucabtagene autoleucel (Tecartus), MACE was exclusively observed within 15 days, and ICANS was shown to persist or occur up to day 30. Hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory syndrome overlapping with CRS, was documented in both classes through day 30 alongside myelitis, which occurred between days 15 and 30.

In contrast, patients receiving anti-BCMA therapies, including ciltacabtagene autoleucel (Carvykti; cilta-cel) and idecabtagene vicleucel (Abecma; ide-cel), exhibited a unique cluster of late onset neurological and gastrointestinal AEs. Cranial nerve palsy and peripheral neuropathy emerged beyond day 15 and continued through day 90 and beyond. Parkinsonism was observed exclusively in the BCMA-targeted cohort from day 30 through day 90 and beyond, with a documented mean onset of 4 days after infusion for ide-cel and 7 days after infusion for cilta-cel. Enterocolitis was noted as a late onset toxicity occurring strictly after day 90 in the BCMA class. Finally, both classes of CAR-T therapy demonstrated an elevated risk for the development of second primary malignancies (SPM), which was observed beyond the 90-day post-infusion mark.

Reference

Alegria V, Bailey B, Coignet H. Safety profiles of CAR-T therapies targeting CD19 or B-cell maturation antigen for treatment of hematologic malignancies. Presented at: 51st Annual Oncology Nursing Society (ONS) Congress; May 13-17, 2026; San Antonio, TX. Poster I3.