CARs, CRS and neurotoxicity: severe complications after administration of immunotherapy : Essentials for intensivists

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 115; no. 3; pp. 198 - 204
• Main Authors: Prinz, J, d'Hargues, Y, Gödel, P, Shimabukuro-Vornhagen, A, Kochanek, M, Böll, B
• Format: Journal Article
• Language: German
• Published: Germany 01.04.2020
• Subjects: Cytokine release syndrome; CAR T‑cell-related encephalopathy syndrome; Tocilizumab; CAR T‑cells; Interleukin-6
• ISSN: 2193-6226
• DOI: 10.1007/s00063-018-0518-7

The development of chimeric antigen receptor (CAR) T‑cells has shown promising results in relapsed/refractory B‑cell acute lymphoblastic leukemia/lymphoma (B-ALL) and diffuse large cell B‑cell lymphoma. Complications, especially cytokine release syndrome (CRS) and CAR T‑cell related encephalopathy syndrome (CRES), can be life threatening. The management of both plays a key role in CAR T‑cell therapy. Diagnosis, clinical presentation and development of complications in the treatment with CAR T‑cells. Summary of incidence, mortality and treatment of severe complications after administration of CAR T‑cells referring to current studies and therapy recommendations. Complications after administration of CAR T‑cells, especially CRS and CRES, can be life threatening. The timely identification of side effects and their appropriate treatment usually leads to complete recovery. Using a therapy algorithm in the treatment with CAR T‑cells allows safe management of toxicities and can be helpful in recognizing them in time.