Acute life-threatening toxicity from CAR T-cell therapy

Excerpt

Chimeric antigen receptor (CAR) T-cell therapy is an effective adoptive cell treatment that constitutes a powerful new class of therapeutic agents to treat patients with B‐cell leukemia and lymphoma [1]. It uses patient’s T lymphocytes harvested through cytapheresis and manipulated ex vivo to express specific antigens before infusion back to the patient. Although the clinical responses are beyond expectations, CAR T-cells also frequently produce life-threatening acute toxicities [2], chiefly the cytokine-release syndrome (CRS) and neurotoxicity (Fig. 1). Tumor lysis syndrome that has been reported in up to 5% of the patients in the first trials, is not discussed in this short article. Obviously, in these high risk immunocompromised patients with altered B cell and T cell response and frequent neutropenia, sepsis should be ruled out and treated empirically. In this what’s new paper, we have listed the top ten tips to manage critically ill CAR T-cell recipients.

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