[The critically ill CAR T-cell patient : Relevant toxicities, their management and challenges in critical care]. / Der kritisch kranke Patient nach CAR-T-Zell-Therapie : Relevante Nebenwirkungen, deren Management und Herausforderungen an die Intensivmedizin.
Med Klin Intensivmed Notfmed
; 116(2): 121-128, 2021 Mar.
Article
en De
| MEDLINE
| ID: mdl-33564900
ABSTRACT
BACKGROUND:
CART cell therapy has been implemented as clinical routine treatment option during the last decade. Despite beneficial outcomes in many patients severe side effects and toxicities are seen regularly that can compromise the treatment success.METHODS:
Literature review CAR Tcell therapy, toxicities and their managementRESULTS:
The cytokine release syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS) are seen regularly after CAR Tcell treatment. CRS symptoms can range from mild flu-like symptoms to severe organ dysfunction requiring vasopressor therapy, mechanical ventilation and other intensive care support. ICANS symptoms usually develop later and can range from disorientation and aphasia to potentially life-threatening brain edema. IL6 is a key factor in the pathophysiology of CRS. The pathophysiology of ICANS is not fully understood. The ASTCT consensus grading is recommended to stratify patients for different management options. An interdisciplinary team including hematologist, intensivist, neurologists and other specialties is needed to optimize the treatment.DISCUSSION:
Severe and potentially life-threatening toxicities occur regularly after CAR Tcell therapy. Treatment strategies for CRS and ICANS still need to be evaluated prospectively. Due to the increasing number of patients treated with CAR Tcells the number of patients requiring temporary intensive care management due to CRS and ICANS is expected to increase during the next years.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Inmunoterapia Adoptiva
/
Enfermedad Crítica
Límite:
Humans
Idioma:
De
Revista:
Med Klin Intensivmed Notfmed
Año:
2021
Tipo del documento:
Article