Complications of emerging oncology therapies requiring treatment in the pediatric intensive care unit Review
| Authors: | Killinger, J. S.; Hurley, C.; Wasserman, E.; McArthur, J. |
| Review Title: | Complications of emerging oncology therapies requiring treatment in the pediatric intensive care unit |
| Abstract: | Purpose of the Review: The development of immunotherapies has resulted in significant improvements in survival for children with cancer and congenital blood disorders. The purpose of this review is to guide the recognition and treatment of significant side of effects three increasingly used immunotherapies—T cell-mediated therapies, immune checkpoint inhibitors, and anti-GD2 antibodies. Recent Findings: Cytokine release syndrome (CRS) is a cytokine-induced systemic inflammatory state secondary to chimeric antigen receptor T cells (CAR–T cells), a therapy used for relapsed and refractory leukemia. CRS can range from fever and mild flu-like symptoms to cardiopulmonary collapse and neurologic sequelae including encephalitis, seizures, and cerebral edema. Immune check point inhibitors work to redirect the T cell response towards cancer cells and have shown a survival advantage for patients with advanced melanoma. These agents also activate an immune response which can mimic autoimmune disease and cause organ failure and neurologic complications like Guillain–Barre and posterior reversible encephalopathy. Children with high-risk and chemotherapy-resistant neuroblastoma have seen improved survival with the use of anti-GD2, an immunotherapy directed at the highly abundant and conserved GD2 antigen expressed on neuroblastoma cells. Severe pain is the consistently reported side effect of anti-GD2, occurring in an estimated 50% of patients and often requiring narcotic and sedative agents for the duration of therapy. Summary: Immunotherapy has become critical to the treatment of previously irremediable diseases like relapsed leukemia and refractory neuroblastoma. The survival advantage offered by these therapies requires an understanding of diagnosis and treatment of their life-threatening toxicities. © 2017, Springer Science+Business Media, LLC. |
| Keywords: | childhood cancer; neuroblastoma; cytokine release syndrome; cytotoxic t lymphocytes; checkpoint inhibitors; chimeric antigen receptor t cells |
| Journal Title: | Current Pediatrics Reports |
| Volume: | 5 |
| Issue: | 4 |
| ISSN: | 2167-4841 |
| Publisher: | Springer Healthcare |
| Date Published: | 2017-12-01 |
| Start Page: | 220 |
| End Page: | 227 |
| Language: | English |
| DOI: | 10.1007/s40124-017-0145-4 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Export Date: 1 March 2022 -- Source: Scopus |
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