4.7 Review

Side-effect management of chimeric antigen receptor (CAR) T-cell therapy

Journal

ANNALS OF ONCOLOGY
Volume 32, Issue 1, Pages 34-48

Publisher

ELSEVIER
DOI: 10.1016/j.annonc.2020.10.478

Keywords

Chimeric antigen receptor (CAR) T cells; cytokine release syndrome (CRS); immune effector cell-associated neurotoxicity syndrome (ICANS); CAR T-cell associated side-effects; CAR T-cell side-effect management

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Funding

  1. Olympia Morata Program of the Medical Faculty of the University of Heidelberg [08/2019, 8/2019]
  2. SCOR Grant Leukemia and Lymphoma
  3. SPORE grant of the National Institute of Health/National Cancer Institute [3P50CA126752]

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CAR T-cell therapy targeting CD19-expressing B cells has shown promising results in treating refractory and/or relapsed B-cell malignancies, but also presents challenges such as cytokine release syndrome and neurotoxicity syndrome. Optimal management strategies for the side-effects associated with CAR T-cell therapy are crucial as it expands into other diseases in hematology and oncology.
Chimeric antigen receptor (CAR) T cells directed against the B-cell marker CD19 are currently changing the landscape for treatment of patients with refractory and/or relapsed B-cell malignancies. Due to the nature of CAR T cells as living drugs, they display a unique toxicity profile. As CAR T-cell therapy is extending towards other diseases and being more broadly employed in hematology and oncology, optimal management strategies of side-effects associated with CAR T-cell therapy are of high relevance. Cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and cytopenias constitute challenges in the treatment of patients with CAR T cells. This review summarizes the current understanding of CAR T-cell toxicity and its management.

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