Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen receptor ‐modified (CAR‐) T cell therapy

SummaryChimeric antigen receptor ‐modified (CAR)‐T cells have demonstrated impressive results in the treatment of haematological malignancies. However, cytokine release syndrome (CRS) and neurotoxicity are common toxicities which are potentially life‐threatening in severe cases. Risk factors for CRS and neurotoxicity identifi ed so far include disease burden, lymphodepletion intensity and CAR‐T cell dose administered. Risk‐adapted dosing, with lower CAR‐T cell doses administered to B‐cell acute lymphoblastic leukaemia patients with high marrow blast counts, has been successful at decreasing severe CRS rates in th is population. Intervention with therapies, such as tocilizumab and corticosteroids, have been effective at ameliorating toxicity, enabling CAR‐T cells to be administered safely to many patients without significantly compromising efficacy. Deeper understanding of the pathophysiology of underlying CRS and neurotoxicity will enable the development of novel approaches to reduce toxicity and improve outcomes.
Source: British Journal of Haematology - Category: Hematology Authors: Tags: Review Source Type: research