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Critically Ill Patients Treated for Chimeric Antigen Receptor-Related Toxicity

By Currents Editor posted 07-30-2021 11:37

  

Critical Care Medicine (07/02/21) DOI: 10.1097/CCM.0000000000005149

Gutierrez, Cristina; Brown, Anne Rain T.; May, Heather P.; et al.

https://journals.lww.com/ccmjournal/Abstract/9000/Critically_Ill_Patients_Treated_for_Chimeric.95168.aspx 

In a new study, U.S. researchers report a multicenter cohort of patients who required ICU admission due to cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor (CAR) T-cell therapy. The retrospective cohort study included 105 adult patients treated with axicabtagene ciloleucel who experienced CRS or immune effector cell-associated neurotoxicity syndrome between November 2017 and May 2019. When admitted to the ICU, 66.7% of the patients had grade 3–4 toxicities, including 15.2% with grade 3–4 CRS and 64% with grade 3–4 immune effector cell-associated neurotoxicity syndrome. While in the ICU, CRS was observed in 77.1% of patients and immune effector cell-associated neurotoxicity syndrome was seen in 84.8% of patients. A total of 61.9% of the patients had both conditions. Additionally, while 79% of patients developed grade 3 or higher toxicities while in the ICU, vasopressors, mechanical ventilation, and dialysis were not required often. Conditions including Immune Effector Cell-Associated Encephalopathy score less than 3, seizures, status epilepticus, motor deficits, and cerebral edema were more common. Overall, 8.6% of the patients died while in ICU; however, only three deaths were related to CRS or immune effector cell-associated neurotoxicity syndrome. The median overall length of survival was 10.4 months. The researchers note that neither toxicity grade nor organ support affected overall survival, while higher cumulative doses of corticosteroids were linked with reduced overall survival and progression-free survival.

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