增加使用嵌合抗原受体T细胞疗法（CAR-T）揭示了多样的毒性，需要特定的认知和管理。 CAR-T输注后发生的细胞减少常常表现为早期（<30天），通常是长期的（30-90天），有时持续存在或晚期发生（>90天）。这些细胞减少的病因可能有所不同，其中一些仍未完全理解，这在临床上创建了难题和关于最佳管理策略的不确定性。这些细胞减少可能会导致其他的后续影响，降低生活质量和增加资源利用。早期细胞减少通常被归因于淋巴毁损化疗，但感染和免疫效应细胞相关的溶血性淋巴组织细胞吞噬综合征等过度炎症反应也可能发生。早期和长期的细胞减少常常与细胞因子释放综合征或免疫效应细胞相关的神经毒性综合征的严重程度相关。在出现长期或晚期细胞减少的患者中进行骨髓活检对于评估原发疾病和两类患者的继发骨髓肿瘤非常重要。通常，细胞减少会随着时间的推移自然恢复，有效干预的证据往往只是零星的。治疗策略受限，需要根据可能的潜在病因来制定，包括生长因子、血小板生成素受体激动剂、干细胞移植、输血支持和消除感染风险。在这里，我们提供了我们的方法，包括检查和管理策略，用于CAR-T后出现的细胞减少。版权所有 © 2023美国血液学会。

Increasing use of chimeric antigen receptor T-cell therapy (CAR-T) has unveiled diverse toxicities warranting specific recognition and management. Cytopenias occurring after CAR-T infusion invariably manifest early (<30 days), commonly are prolonged (30-90 days), and sometimes persist or occur late (>90 days). Variable etiologies of these cytopenias, some of which remain incompletely understood, create clinical conundrums and uncertainties about optimal management strategies. These cytopenias may cause additional sequelae, decreased quality of life, and increased resource utilization. Early cytopenias are typically attributed to lymphodepletion chemotherapy however infections and hyperinflammatory response such as immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome may occur. Early and prolonged cytopenias often correlate with severity of cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Bone marrow biopsy in patients with prolonged or late cytopenias is important to evaluate for primary disease and secondary marrow neoplasm in both pediatric and adult patients. Commonly cytopenias resolve over time and evidence for effective interventions is often anecdotal. Treatment strategies, which are limited and require tailoring based upon likely underlying etiology, include growth factors, thrombopoietin-receptor agonist, stem cell boost, transfusion support, and abrogation of infection risk. Here we provide our approach, including workup and management strategies, for cytopenias following CAR-T.Copyright © 2023 American Society of Hematology.