How I treat unique and difficult-to-manage cases of CAR T-cell therapy–associated neurotoxicity Journal Article
| Authors: | Santomasso, B. D.; Gust, J.; Perna, F. |
| Article Title: | How I treat unique and difficult-to-manage cases of CAR T-cell therapy–associated neurotoxicity |
| Abstract: | With growing indications for chimeric antigen receptor (CAR) T-cell therapy, toxicity profiles are evolving. There is an urgent and unmet need of approaches to optimally manage emerging adverse events that extend beyond the standard paradigm of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS). Although management guidelines exist for ICANS, there is little guidance on how to approach patients with neurologic comorbidities, and how to manage rare neurotoxicity presentations, such as CAR T-cell therapy–related cerebral edema, severe motor complications or late-onset neurotoxicity. In this study, we present 3 scenarios of patients treated with CAR T cells who develop unique types of neurotoxicity, and we describe an approach for the evaluation and management based on experience because objective data are limited. The goal of this study is to develop an awareness of emerging and unusual complications, discuss treatment approaches, and help institutions and health care providers establish frameworks to navigate how to best address unusual neurotoxicities to ultimately improve patient outcomes. © 2023 The American Society of Hematology |
| Keywords: | adult; cancer chemotherapy; child; clinical article; preschool child; treatment response; aged; review; case report; methotrexate; drug megadose; neuroimaging; neurotoxicity; nuclear magnetic resonance imaging; multiple myeloma; lorazepam; dexamethasone; immunoglobulin; steroid; autologous stem cell transplantation; acute lymphoblastic leukemia; drug dose escalation; confusion; hyponatremia; papilledema; lumbar puncture; health care personnel; sepsis; methylprednisolone; seizure; leukocyte count; aphasia; drug dose increase; leukemia relapse; immunoglobulin kappa chain; urine retention; tremor; sodium chloride; health personnel; adoptive immunotherapy; immunotherapy, adoptive; brain edema; multiple organ failure; agitation; artificial ventilation; arm weakness; leukemia remission; medical history; respiratory tract intubation; disorientation; spine radiography; respiratory distress; cytokine release syndrome; diffuse large b cell lymphoma; fosphenytoin sodium; protein cerebrospinal fluid level; neurotoxicity syndromes; babinski reflex; pentobarbital; tocilizumab; thiamine; levetiracetam; nivolumab; paraplegia; disease burden; comatose patient; humans; human; male; female; b cell maturation antigen; chimeric antigen receptor t-cell immunotherapy; axicabtagene ciloleucel; delta rhythm; anakinra; toxicity and intoxication; idecabtagene vicleucel; cell-associated neurotoxicity; consciousness level; fluid-attenuated inversion recovery imaging; generalized convulsive seizure; non-convulsive epilepsy |
| Journal Title: | Blood |
| Volume: | 141 |
| Issue: | 20 |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2023-05-18 |
| Start Page: | 2443 |
| End Page: | 2451 |
| Language: | English |
| DOI: | 10.1182/blood.2022017604 |
| PUBMED: | 36877916 |
| PROVIDER: | scopus |
| PMCID: | PMC10329188 |
| DOI/URL: | |
| Notes: | Review -- Export Date: 31 May 2023 -- Source: Scopus |
