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Review
. 2021 Jan;32(1):34-48.
doi: 10.1016/j.annonc.2020.10.478. Epub 2020 Oct 21.

Side-effect management of chimeric antigen receptor (CAR) T-cell therapy

M-L Schubert  1 , M Schmitt  2 , L Wang  3 , C A Ramos  4 , K Jordan  3 , C Müller-Tidow  2 , P Dreger  2
Affiliations
Free article
Review

Side-effect management of chimeric antigen receptor (CAR) T-cell therapy

M-L Schubert et al. Ann Oncol. 2021 Jan.
Free article

Abstract

Chimeric antigen receptor (CAR) T cells directed against the B-cell marker CD19 are currently changing the landscape for treatment of patients with refractory and/or relapsed B-cell malignancies. Due to the nature of CAR T cells as living drugs, they display a unique toxicity profile. As CAR T-cell therapy is extending towards other diseases and being more broadly employed in hematology and oncology, optimal management strategies of side-effects associated with CAR T-cell therapy are of high relevance. Cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and cytopenias constitute challenges in the treatment of patients with CAR T cells. This review summarizes the current understanding of CAR T-cell toxicity and its management.

Keywords: CAR T-cell associated side-effects; CAR T-cell side-effect management; Chimeric antigen receptor (CAR) T cells; cytokine release syndrome (CRS); immune effector cell-associated neurotoxicity syndrome (ICANS).

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Conflict of interest statement

Disclosure MLS: Kite/Gilead, Takeda (consultant). MS: Apogenix, Hexal and Novartis (research support). Hexal, Kite/Gilead (travel grants). Bluebird bio, Kite, Novartis (financial support for educational activities and conferences). MSD (advisory board member). MSD, GSK, Kite, BMS [(co-)PI of clinical trials]. TolerogenixX Ltd. (co-founder and shareholder). CAR: Tessa Therapeutics (research funding). Novartis (advisory board meeting member). KJ: Merck Sharp & Dohme, Merck, Amgen, Hexal, Riemser, Helsinn, Tesaro, Kreussler, Voluntis, Pfizer, Pomme-med, art-tempi, prIME Oncology, Onko Update (financial interests, honoraria for speaker, consultancy or advisory role, royalties or direct research funding). CMT: Bayer AG (research support). Pfizer, Janssen-Cilag GmbH (advisory board member). Pfizer, Daiichi Sankyo, BioLineRx (grants and/or provision of investigational medicinal products). PD: AbbVie, AstraZeneca, Gilead, Janssen, Novartis, Riemser, Roche (consultant). AbbVie, Gilead, Novartis, Riemser, Roche (speakers bureau). Neovii, Riemser (research support). LW has declared no conflicts of interest.

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