Currently Viewing:
Newsroom
Currently Reading
Blood Clots in MPN Related to Higher Cost, Length of Stay for Patients With MPN
August 17, 2019 – AJMC Staff
FDA Panel Backs Use of Descovy for HIV Prevention in Men, Transgender Women
August 16, 2019 – Jaime Rosenberg
Researcher Excited About Future of Psoriasis Treatment
August 16, 2019 – Allison Inserro
This Week in Managed Care: August 16, 2019
August 16, 2019
AJMC® in the Press, August 16, 2019
August 16, 2019 – AJMC Staff
Pediatric Leukemia Treatment Linked to Increased Risk of Infections, Study Finds
August 16, 2019 – Alison Rodriguez
5 Findings From the August 2019 Issue of AJMC®
August 16, 2019 – Christina Mattina
Treatment for Parental Tobacco Use Shown to Be Significantly Effective in a Pediatric Setting, Study Shows
August 16, 2019 – Matthew Gavidia
What We're Reading: Generic Pricing Probe; EpiPen Coverage; Mass. Insurers to Merge
August 16, 2019 – AJMC Staff

MD Anderson, PALISI Jointly Develop Pediatric Guidelines for CAR T-Cell Therapy

Samantha DiGrande
Researchers from the University of Texas MD Anderson Cancer Center, along with the Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI), recently published guidelines in Nature Reviews Clinical Oncology for the management of chimeric antigen receptor (CAR) T-cell therapy for children with acute lymphoblastic leukemia.
Researchers from the University of Texas MD Anderson Cancer Center, along with the Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI), recently published guidelinesin Nature Reviews Clinical Oncology for the management of chimeric antigen receptor (CAR) T-cell therapy for children with acute lymphoblastic leukemia (ALL).

Although CAR T-cell therapy has shown largely positive results in both hematological and nonhematological malignancies, it has also been associated with unique acute toxicities, such as cytokine-release syndrome (CRS), which can be severe or even fatal. The guidelines look to summarize lessons learned by experts in various fields in regard to identifying early signs and symptoms of treatment-related toxicity and ways to manage it. 

“CAR T-cell therapy has been associated with remarkable response rates for children and young adults with ALL, yet this innovative form of cellular immunotherapy has resulted in unique and severe toxicities which can lead to rapid cardiorespiratory and/or neurological deterioration,” said Kris Mahadeo, MD, associate professor of pediatrics and chief of Stem Cell Transplant and Cellular Therapy at MD Anderson, in a statement.

MD Anderson’s CAR T-cell therapy–associated Toxicity (CARTOX) program collaborated with PALISI and its Hematopoietic Stem Cell Transplantation subgroup in the creation of the guidelines. The joint effort brought together experts from a multitude of fields, including pediatric intensivists, pharmacy, neurology, and translational immunotherapy research, and looked to improve the patient experience and outcomes.

Some key recommendations include:
  • Patient selection should be based upon indications approved by the FDA and the criteria used in pivotal studies but can be tailored on the basis of emerging information from each new product.
  • When appropriate, child assent should also be obtained; age-appropriate advance directives should be considered. Incorporation of child life and psychological services in assent discussions can also be helpful.
  • Parent and/or caregiver concerns should be addressed because early signs of CRS can be subtle and best recognized by those who are most familiar with the child.
  • If CAR T-cell therapy is administered in an outpatient setting, a low threshold should be set for patiet admission upon the development of a fever and/or signs or symptoms that are suggestive of CRS and/or CAR T cell–related encephalopathy syndrome.
These guidelines act as a follow-up to the guidelines previously published in 2017 in Nature Reviews Clinical Oncology on the management of adult patients receiving CAR T-cell therapy. However, given the early signs and symptoms of toxicity in children and how quickly deterioration can happen, researchers saw the need for pediatric-specific monitoring guidelines, including the escalation of care based on parent and caregiver concerns. 

References

1. Mahadeo K, Khazal S, Abdel-Azim H, et al. Management guidelines for pediatric patients receiving chimeric antigen receptor T cell therapy [published online August 6, 2018]. Nat Rev Clin Oncol. doi: 10.1038/s41571-018-0075-2.

2. Neelapu S, Tummala S, Kebriaei P, et al. chimeric antigen receptor T-cell therapy–assessment and management of toxicities. Nat Rev Clin Oncol. 2018;15:47-62. doi: 10.1038/nrclinonc.2017.148.

Related Articles

Gene Editing Could Limit Toxicity of CAR T Treatment in AML
RA Drug May Reduce Toxicity Caused By CAR T Treatment
FDA Accepts First Allogeneic CAR T-Cell Therapy Trial
 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up