Cristina Gutierrez1, Colleen McEvoy2, Elena Mead3, R Scott Stephens4, Laveena Munshi5, Michael E Detsky6, Stephen M Pastores7, Joseph L Nates8. 1. Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX. 2. Stem Cell Transplant and Oncology Intensive Care Unit, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO. 3. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY. 4. Oncology and Bone Marrow Transplant Critical Care, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 5. Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, Toronto, ON, Canada. 6. Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, Toronto, ON, Canada. 7. Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 8. Weill Cornell Medical College, New York, NY.
Abstract
OBJECTIVES: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. DATA SOURCES: PubMed and Medline search of articles published from 2006 to date. STUDY SELECTION: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. DATA EXTRACTION: Not available. DATA SYNTHESIS: Not available. CONCLUSIONS: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.
OBJECTIVES: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. DATA SOURCES: PubMed and Medline search of articles published from 2006 to date. STUDY SELECTION: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. DATA EXTRACTION: Not available. DATA SYNTHESIS: Not available. CONCLUSIONS: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.
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