Critically Ill Patients Treated for Chimeric Antigen Receptor-Related Toxicity: A Multicenter Study.
Crit Care Med
; 50(1): 81-92, 2022 01 01.
Article
en En
| MEDLINE
| ID: mdl-34259446
ABSTRACT
OBJECTIVES:
To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.DESIGN:
Retrospective cohort study.SETTING:
Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative. PATIENTS Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019.INTERVENTIONS:
Demographics, toxicities, specific interventions, and outcomes were collected.RESULTS:
One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3-4 toxicities (66.7%); 15.2% had grade 3-4 cytokine release syndrome and 64% grade 3-4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64-not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival.CONCLUSIONS:
This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Productos Biológicos
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Inmunoterapia Adoptiva
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Enfermedad Crítica
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Síndromes de Neurotoxicidad
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Receptores Quiméricos de Antígenos
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Síndrome de Liberación de Citoquinas
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Crit Care Med
Año:
2022
Tipo del documento:
Article