Toxicity after chimeric antigen receptor T-cell therapy Overview and management of early and late onset side effects

被引:4
作者
Borrega, Jorge Garcia [1 ,2 ]
Heindel, Katrin [1 ,2 ]
Goereci, Yasemin [3 ]
Warnke, Clemens [3 ]
Onur, Oezguer A. [3 ]
Kochanek, Matthias [1 ,2 ]
Schub, Natalie [4 ]
Ayuk, Francis [5 ]
Wichmann, Dominic [6 ]
Boell, Boris [1 ,2 ]
机构
[1] Klinikum Univ Koln, Klin Innere Med Hamatol Onkol & Internist Intensi, Kerpener Str 62, D-50937 Cologne, Germany
[2] Klinikum Univ Koln, Klin Innere Med 1, Ctr Integrierte Onkol Aachen Bonn Koln Dusseldorf, Cologne, Germany
[3] Univ Klinikum Koln, Klin Neurol, Cologne, Germany
[4] Univ Klin Schleswig Holstein, Med Klin 2, Campus Kiel, Kiel, Germany
[5] Univ Klinikum Hamburg Eppendorf, Med Klin 2, Hamburg, Germany
[6] Univ Klinikum Hamburg Eppendorf, Zentrum Anasthesiol & Intens Med, Hamburg, Germany
来源
INTERNIST | 2021年 / 62卷 / 06期
关键词
Cytokine release syndrome; Immune effector cell-associated neurotoxicity syndrome; Hypogammaglobulinemia; Tocilizumab; Corticosteroids; NEUROTOXICITY; CD19;
D O I
10.1007/s00108-021-01046-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The transfusion of chimeric antigen receptor (CAR) T-cells has become established as a new treatment option in oncology; however, this is regularly associated with immune-mediated side effects, which can also run a severe course and necessitate a specific treatment and intensive medical treatment. Material and methods. A literature review was carried out on CAR T-cell therapy, toxicities and the management of side effects. Results. The cytokine release syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS) regularly occur shortly after CAR T-cell treatment. The symptoms of CRS can range from mild flu-like symptoms to multiorgan failure. In addition to mild symptoms, such as disorientation and aphasia, ICANS can also lead to convulsive seizures and brain edema. The management of CRS and ICANS is based on the severity according to the grading of the American Society for Transplantation and Cellular Therapy (ASTCT). Tocilizumab and corticosteroids are recommended for CRS and corticosteroids are used for ICANS. In the further course persisting hypogammaglobulinemia and cytopenia are frequent even months after the initial treatment and promote infections even months after CAR T-cell therapy. Discussion. Potentially severe complications regularly occur after CAR T-cell therapy. An interdisciplinary cooperation between intensive care physicians, hematologists, neurologists and specialists in other disciplines is of decisive importance for the optimal care of patients after CAR T-cell therapy.
引用
收藏
页码:611 / 619
页数:9
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