Management of CAR T-cell Related Toxicities: What did the Learning Curve Teach us so Far?

Hematol Oncol Stem Cell Ther. 2022 Nov 7;15(3):100-111. doi: 10.56875/2589-0646.1029.

Abstract

Chimeric antigen receptor T cell (CAR-T) therapy is an immunotherapy, which represents a therapeutic breakthrough in the treatment of B-cell malignancies and multiple myeloma. Since the first CAR T-cell approval in 2017, there have been five FDA approved CAR-T products, more approved disease indications for CAR-T therapy, and investigational trials launched for other cancers, including solid organ malignancies. CAR-T therapy possesses unique toxicities. Better understanding of these toxicities over time has helped in more efficient diagnosis, management, and treatment strategies. This review will focus on CAR-T-related toxicities including cytokine release syndrome, immune effector cell associated neurotoxicity syndrome (ICANS), cytokine release syndrome (CRS), and hemophagocytic lymphohistiocytosis (HLH)/ macrophage activation syndrome in terms of assessment, grading, and current management strategies. Additionally, this review will cover future directions and research on CAR-T-related toxicities.

Publication types

  • Review

MeSH terms

  • Cytokine Release Syndrome / etiology
  • Cytokine Release Syndrome / therapy
  • Humans
  • Learning Curve
  • Neoplasms* / drug therapy
  • Receptors, Antigen, T-Cell / therapeutic use
  • Receptors, Chimeric Antigen* / therapeutic use
  • T-Lymphocytes

Substances

  • Receptors, Chimeric Antigen
  • Receptors, Antigen, T-Cell