Managing Acute Toxicity in CAR T-Cell Therapy

Action Points

  • New guidelines have been proposed that provide step-by-step instructions for the management of toxicities associated with chimeric antigen receptor (CAR) T-cell therapy that could significantly reduce morbidity and mortality associated with treatment in patients with refractory malignancies.
  • Recognize that CAR T-cell therapy is a promising approach for the treatment of refractory malignancies, but is associated with unique acute toxicities that need specialized monitoring and management.

New guidelines that provide step-by-step instructions for the management of toxicities associated with chimeric antigen receptor (CAR) T-cell therapy could significantly reduce the morbidity and mortality seen in patents with refractory malignancies, the authors said.

The grading system and management guidelines for the most commonly observed toxicity — cytokine release syndrome (CRS) — have been updated, and the neurotoxicity associated with this potentially curative immunotherapy has been better defined as CAR-T-cell related encephalopathy syndrome (CRES), Sattva S. Neelapu, MD, PhD, of The University of Texas MD Anderson Cancer Center in Houston, and colleagues, reported online in Nature Reviews Clinical Oncology.

A new grading system and management guidelines for CRES that is objective and quantitative have also been proposed, and new diagnostic criteria and management guidelines are provided for hemophagocytic lymphohistiocytosis (HLH), a rare complication…

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