Clinical care of chimeric antigen receptor T-cell patients and managing immune-related adverse effects in the ambulatory and hospitalized setting: a review.

Chimeric antigen receptor (CAR) T-cell therapies are increasingly providing options for care of oncology patients with advanced hematologic malignancies, which has led to two US FDA approvals. However, they are often associated with significant immune related adverse events that require prompt management. These toxicities are mainly cytokine release syndrome and neurotoxicity, and can be managed in an appropriate setting when presenting to nononcologists or internists. This paper discusses patient management for these toxicities. A management approach can be determined by the severity of the toxicity. Tocilizumab, a humanized monoclonal antibody, was FDA approved for the treatment of cytokine release syndrome, and corticosteroids may be used. Neurotoxicity is generally managed with supportive care and steroidal therapy.