Management of cytokine release syndrome related to CAR-T cell therapy.
Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.
['Chen|Hongli|H|', 'Wang|Fangxia|F|', 'Zhang|Pengyu|P|', 'Zhang|Yilin|Y|', 'Chen|Yinxia|Y|', 'Fan|Xiaohu|X|', 'Cao|Xingmei|X|', 'Liu|Jie|J|', 'Yang|Yun|Y|', 'Wang|Baiyan|B|', 'Lei|Bo|B|', 'Gu|Liufang|L|', 'Bai|Ju|J|', 'Wei|Lili|L|', 'Zhang|Ruili|R|', 'Zhuang|Qiuchuan|Q|', 'Zhang|Wanggang|W|', 'Zhao|Wanhong|W|', 'He|Aili|A|']
D000293:Adolescent D061067:Antibodies, Monoclonal, Humanized D000080424:Cytokine Release Syndrome D016207:Cytokines D003907:Dexamethasone D006801:Humans D016219:Immunotherapy, Adoptive D008297:Male D008875:Middle Aged D009101:Multiple Myeloma D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma D011788:Quality of Life D011948:Receptors, Antigen, T-Cell D000076962:Receptors, Chimeric Antigen D055815:Young Adult
cytokine release syndrome tocilizumab chimeric antigen receptor T cell