Lori A. Leslie, MD, assistant professor, Hackensack Meridian School of Medicine, director, Indolent Lymphoma and Chronic Lymphocytic Leukemia Research Programs, John Theurer Cancer Center, and Andre H. Goy, MD, Hackensack Meridian Chief Medical Officer Health Oncology Care Transformation Services, President and Chief Medical Officer of the John Theurer Cancer Center at Hackensack University Medical Center, and Chief of the John Theurer Cancer Center Lymphoma Division, discuss optimal strategies for CAR T-cell related adverse events (AEs) .
Preventative strategies with tocilizumab (Actemra) and steroids may help alleviate acute AEs associated with CAR T-cell therapy. After infusion of CAR T-cell therapy, important long-term AEs to be aware of include cytopenias, immunoglobulin (Ig) recovery, immune system recovery, and hypogammaglobulinemia, according to Goy and Leslie. Currently, with supportive care, approximately 75% of patients recover their CD4 and Ig levels 2 years after infusion.
Short-term AEs to be aware of are cytokine release syndrome (CRS) and neurotoxicity, Leslie says. Notably, neurotoxicity, which can be a concerning early-onset toxicity, usually resolves completely, Goy says. In early phase studies with CAR T-cell therapy, intervention was more common for grade 3 CRS or neurotoxicity. Now, earlier intervention strategies are being recommended, which has led to milder presentations of these AEs, such as fever and blood pressure changes, Leslie says. Notably, such interventions did not negatively affect efficacy results, adds Leslie. Ultimately, close monitoring during the first post-infusion period is necessary, when CRS and neurotoxicity are most common, because neurotoxicity, for example, can present as something as subtle as a change writing or something as serious as encephalopathy,” concludes Leslie.