Table of contents

Expand All Topics

CAR T-cell therapy-related toxicities

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of CAR T-cell therapy-related toxicities are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2021).
1

Diagnostic investigations

Evaluation for cytokine release syndrome: as per ASCO 2021 guidelines, obtain CBC, comprehensive metabolic panel, magnesium, phosphorus, CRP, LDH, uric acid, fibrinogen, PT/PTT, and ferritin for the evaluation for cytokine release syndrome.
B
Show 6 more
Create free account

More topics in this section

  • Evaluation for immune effector cell-associated neurotoxicity syndrome

  • Evaluation for hemophagocytic lymphohistiocytosis

  • Evaluation for cytopenia

  • Evaluation for B-cell aplasia

  • Evaluation for DIC

  • Evaluation for infections

Medical management

Setting of care: as per ASCO 2021 guidelines, consider obtaining an evaluation and/or transferring to a specialty center experienced in managing CAR T-cell therapy toxicity. If treatment occurs in an outpatient setting, ensure patients remain within 2 hours of the treating center for 4-8 weeks post-therapy and instruct them to return to the treating center upon experiencing any toxicities.
C
Create free account

More topics in this section

  • Management of cytokine release syndrome (G1)

  • Management of cytokine release syndrome (G2)

  • Management of cytokine release syndrome (G3)

  • Management of cytokine release syndrome (G4)

  • Management of cytokine release syndrome (additional considerations)

  • Management of immune effector cell-associated neurotoxicity syndrome (G1)

  • Management of immune effector cell-associated neurotoxicity syndrome (G2)

  • Management of immune effector cell-associated neurotoxicity syndrome (G3)

  • Management of immune effector cell-associated neurotoxicity syndrome (G4)

  • Management of hemophagocytic lymphohistiocytosis

  • Management of cytopenia

  • Management of B-cell aplasia

  • Management of DIC

  • Management of infections

Preventative measures

Immunizations
As per ASCO 2021 guidelines:
Offer inactivated influenza and COVID-19 vaccination for patients and family members. Although the immunogenicity and efficacy of COVID-19 vaccines are uncertain in patients receiving immunomodulatory agents, recognize that the potential for benefit from vaccination likely outweighs these uncertainties for most patients.
B
Delay CAR T-cell infusion in patients with active infection until the infection has been successfully treated or controlled.
B
Create free account