Bianca D Santomasso1, Loretta J Nastoupil2, Sherry Adkins2, Christina Lacchetti3, Bryan J Schneider4, Milan Anadkat5, Michael B Atkins6, Kelly J Brassil2, Jeffrey M Caterino7, Ian Chau8, Marianne J Davies9, Marc S Ernstoff10, Leslie Fecher4, Pauline Funchain11, Ishmael Jaiyesimi12, Jennifer S Mammen13, Jarushka Naidoo14, Aung Naing2, Tanyanika Phillips15, Laura D Porter16, Cristina A Reichner17, Carole Seigel18, Jung-Min Song11, Alexander Spira19, Maria Suarez-Almazor2, Umang Swami20, John A Thompson21, Praveen Vikas22, Yinghong Wang2, Jeffrey S Weber23, Kathryn Bollin24, Monalisa Ghosh25. 1. Memorial Sloan Kettering Cancer Center, New York, NY. 2. MD Anderson Cancer Center, Houston, TX. 3. American Society of Clinical Oncology, Alexandria, VA. 4. University of Michigan Health System, Ann Arbor, MI. 5. Washington University, St Louis, MO. 6. Georgetown Lombardi Comprehensive Cancer Center, Washington, DC. 7. The Ohio State University Wexner Medical Center, Columbus, OH. 8. Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom. 9. Smilow Cancer Hospital and Yale School of Nursing, New Haven, CT. 10. National Cancer Institute, Bethesda, MD. 11. Cleveland Clinic, Cleveland, OH. 12. Cancer Care Associates PC, Royal Oak, MI. 13. Johns Hopkins University, Baltimore, MD. 14. Beaumont Hospital, Dublin, Ireland and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD. 15. City of Hope, Duarte, CA. 16. Patient Advocate, Colon Cancer Alliance, Washington, DC. 17. Georgetown University, Washington, DC. 18. Patient Advocate, MGH Cancer Center, Boston, MA. 19. Virginia Cancer Specialists and US Oncology, Fairfax, VA. 20. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT. 21. Seattle Cancer Care Alliance, University of Washington/Fred Hutchinson, Seattle, WA. 22. University of Iowa, Iowa City, IA. 23. NYU Langone Medical Center, New York, NY. 24. Scripps MD Anderson Cancer Center, San Diego, CA. 25. University of Michigan, Ann Arbor, MI.
Abstract
PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell therapy. METHODS: A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021. RESULTS: The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.
PURPOSE: To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell therapy. METHODS: A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021. RESULTS: The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS: The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.
Authors: Caroline Diorio; Rawan Shraim; Regina Myers; Edward M Behrens; Scott Canna; Hamid Bassiri; Richard Aplenc; Chakkapong Burudpakdee; Fang Chen; Amanda M DiNofia; Saar Gill; Vanessa Gonzalez; Michele P Lambert; Allison Barz Leahy; Bruce L Levine; Robert B Lindell; Shannon L Maude; J Joseph Melenhorst; Haley Newman; Jessica Perazzelli; Alix E Seif; Simon F Lacey; Carl H June; David M Barrett; Stephan A Grupp; David T Teachey Journal: Clin Cancer Res Date: 2022-09-01 Impact factor: 13.801
Authors: Caroline Diorio; Anant Vatsayan; Aimee C Talleur; Colleen Annesley; Jennifer J Jaroscak; Haneen Shalabi; Amanda K Ombrello; Michelle Hudspeth; Shannon L Maude; Rebecca A Gardner; Nirali N Shah Journal: Blood Adv Date: 2022-06-14