Chimeric Antigen Receptor T Cells: Toxicity and Management Considerations

Required reading for all learners: Implicit Bias impacts patient outcomes

Chimeric antigen receptor (CAR) T-cell therapies use genetically engineered T cells that mediate T-cell activation and costimulation.1,2 CAR T-cell therapies can produce sustained remission in hematologic malignancies that are refractory to standard therapies. Tisagenlecleucel and axicabtagene ciloleucel are among the first CAR T-cell therapies approved by the US Food and Drug Administration (FDA) for the treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma. CAR T-cell therapies are designed to recognize and bind to specific antigens on tumor cells, leading to CAR T-cell {AQ2} activation and proliferation and eventually resulting in significant and durable destruction of malignant cells. However, these therapies can potentially cause destruction of normal, nonmalignant cells when targeting a tumor-associated antigen also expressed on normal cells. Toxicities related to CAR T cells can occur and may include infusion-related reactions, tumor lysis syndrome, infections, cytokine release syndrome (CRS), and immune effector cell–associated neurotoxicity syndrome (ICANS).