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Chimeric antigen receptor T-cell therapy — assessment and management of toxicities
- Neelapu, Sattva S;
- Tummala, Sudhakar;
- Kebriaei, Partow;
- Wierda, William;
- Gutierrez, Cristina;
- Locke, Frederick L;
- Komanduri, Krishna V;
- Lin, Yi;
- Jain, Nitin;
- Daver, Naval;
- Westin, Jason;
- Gulbis, Alison M;
- Loghin, Monica E;
- de Groot, John F;
- Adkins, Sherry;
- Davis, Suzanne E;
- Rezvani, Katayoun;
- Hwu, Patrick;
- Shpall, Elizabeth J
Published Web Location
https://doi.org/10.1038/nrclinonc.2017.148Abstract
Key PointsChimeric antigen receptor (CAR)-T-cell therapy is a promising approach for the treatment of refractory malignancies, but is associated with unique acute toxicities that need specialized monitoring and managementCytokine-release syndrome (CRS) and CAR-T-cell-related encephalopathy syndrome (CRES) are the most-common toxicities observed after CAR-T-cell therapy and, rarely, CRS can evolve into fulminant haemophagocytic lymphohistiocytosis (HLH)Intensive monitoring, accurate grading, and prompt management of toxicities with aggressive supportive care, anti-IL-6 therapy, and/or corticosteroids for severe cases could reduce the morbidity and mortality associated with CAR-T-cell therapyThe guidelines proposed could also be used for grading and management of toxicities associated with other redirected-T-cell therapies, such as TCR-gene therapies and bispecific T-cell-engaging antibody (BiTE) therapies
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