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Toxicities following CAR-T therapy for hematological malignancies

Published:October 22, 2022DOI:https://doi.org/10.1016/j.ctrv.2022.102479

      Highlights

      • CAR-T therapy is associated with potentially life-threatening toxicities.
      • Immunotoxicity (mainly CRS and ICANS) is common after CAR-T therapy.
      • CRS, ICANS and targeted treatment are risk factors for hematotoxicity and infections.
      • Infections are the most common cause of therapy-related mortality after CAR-T therapy.
      • A multidisciplinary team approach is recommended for toxicity management.

      Abstract

      Chimeric antigen receptor T-cell (CAR-T) therapy has improved outcomes in patients with relapsed/refractory hematological malignancies. Research is also extending to other diseases, including solid tumors, infections and autoimmune disorders. As living drugs, CAR-T cells are associated with potentially life-threatening immunological toxicities, which frequently require a multidisciplinary team approach. Cytokine-release syndrome, immune effector cell-associated neurotoxicity syndrome, infections and hematotoxicity (including cytopenias, immune reconstitution dysfunction and hypogammaglobulinemia) are associated with significant morbidity and mortality. This review takes a practical approach to summarize current knowledge on CAR-T toxicity, addressing pathogeny, risk factors, and prophylactic and therapeutic strategies.

      Keywords

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