Physicians Develop Guidelines to Manage CAR T-Cell Toxicity

Surabhi Dangi-Garimella, PhD

Cytokine release syndrome (CRS) and chimeric antigen receptor (CAR) T cell–related encephalopathy syndrome (CRES) are significant side effects that are not commonly encountered when patients are treated with anticancer agents; however, these are a common phenomenon among patients treated with CAR T-cell therapies. Now, physicians across different institutes who have been involved in clinical trials of CAR T cells in B-cell lymphomas have developed a guideline for managing CRS and CRES.
The review is based on the experiences gained when treating over 100 patients who received care at MD Anderson Cancer Center at the University of Texas, Moffitt Cancer Center in Tampa, Sylvester Cancer Center at the University of Miami, and Mayo Clinic Cancer Center in Rochester, Minneapolis.
Following is an overview of some of the recommendations: The authors have also developed a 3-step flowchart for easier assessment and management of acute toxicities with this treatment, as well as concise tables for identifying and managing different grades of CRS and CRES.
“This represents a sea change in how we treat these patients,” said lead author Sattva Neelapu, MD, professor of Lymphoma and Multiple Myeloma at MD Anderson, in a statement. “There have been no new treatments approved for patients with aggressive B-cell lymphomas relapsing after first line therapy in 30 years, and only about 10% survive long term.”
Highlighting that CAR T-cell infusions are potentially curative, Nellapu added, “The toxicities are unique, and every member of the care team needs to be trained to recognize them and act accordingly.”
Neelapu SS, Tummala S, Kebriaei P, et al. Chimeric antigen receptor T-cell therapy - assessment and management of toxicities. Nat Rev Clin Oncol. 2017. doi: 10.1038/nrclinonc.2017.148.
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