Management of CAR-T cell-related encephalopathy syndrome in adult and pediatric patients: Recommendations of the French Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)

CAR-T cell-related encephalopathy syndrome (CRES) reflects the potential neurotoxicity of this therapeutic approach and must be considered in the presence of any neurological symptom after the infusion of the CAR-T. This is the second most common adverse event under this therapy and its incidence va...

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Published inBulletin du cancer Vol. 107; no. 1S; p. S12
Main Authors Cornillon, Jérôme, Hadhoum, Nawal, Roth-Guepin, Gabrielle, Quessar, Asmaa, Platon, Lara, Ouachée-Chardin, Marie, Nicolas-Virelizier, Emmanuelle, Naudin, Jérôme, Moreau, Anne-Sophie, Masouridi-Levrat, Stavroula, Borel, Cécile, Ahmad, Imran, Beauvais, David, Baruchel, André, Yakoub-Agha, Ibrahim
Format Journal Article
LanguageEnglish
French
Published France 01.01.2020
Subjects
Adrenal Cortex Hormones - therapeutic use
Adult
Anticonvulsants - therapeutic use
Child
Cytokine Release Syndrome - etiology
Cytokine Release Syndrome - therapy
Disease Management
Humans
Immunotherapy, Adoptive - adverse effects
Incidence
Neuroimaging
Neurotoxicity Syndromes - diagnosis
Neurotoxicity Syndromes - epidemiology
Neurotoxicity Syndromes - etiology
Neurotoxicity Syndromes - therapy
Risk Factors
Salvage Therapy
Severity of Illness Index
Syndrome
CRES
Troubles neurologiques
Management
Neurologic disorders
CAR-T
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Summary:CAR-T cell-related encephalopathy syndrome (CRES) reflects the potential neurotoxicity of this therapeutic approach and must be considered in the presence of any neurological symptom after the infusion of the CAR-T. This is the second most common adverse event under this therapy and its incidence varies between 12 and 55%. The median time of the onset of the first neurologic symptoms is 4days after CAR-T infusion. The duration of CRES symptoms is generally between 2 and 4days, but late CRES may occur. Monitoring and diagnosis of CERS includes clinical exam, magnetic resonance imaging and electroencephalography. In addition to symptomatic treatments, corticosteroids represent the cornerstone of the high-grade CERS treatment. Drugs targeting IL-6 should be restricted to severe forms, especially those associated with cytokine release syndrome. The purpose of this workshop is to provide practical help in dealing with this complication.
ISSN:1769-6917
DOI:10.1016/j.bulcan.2019.05.001