Immune effector cell-associated neurotoxicity syndrome: A therapeutic approach in the critically ill.

Autor: Suarez Montero JC; Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: JSuarez@santpau.cat., Caballero Gonzalez AC; Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Martín Aguilar L; Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Mancebo Cortés J; Servicio de Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Medicina intensiva [Med Intensiva (Engl Ed)] 2022 Apr; Vol. 46 (4), pp. 201-212. Date of Electronic Publication: 2022 Feb 22.
DOI: 10.1016/j.medine.2022.02.005
Abstrakt: Immunotherapy with chimeric antigen-specific receptor modified T cells, known as CAR-T, is emerging as a promising approach to hematological malignancies. In this regard, CAR-T against human cluster of differentiation (CD) 19 has demonstrated antitumor efficacy in application to B cell neoplasms resistant to conventional therapy. However, activation of the immune system induces severe and specific complications which can prove life-threatening. These include cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (known as ICANS) - the latter being the subject of the present review. Although the physiopathological mechanisms underlying ICANS are not well known, a number of clinical and biological factors increase the risk of developing neurotoxicity associated to CAR-T therapy. Treatment is based on close monitoring, measures of support, anticonvulsivants, corticosteroids, and early admission to intensive care. The present study offers a comprehensive review of the available literature from a multidisciplinary perspective, including recommendations from intensivists, neurologists and hematologists dedicated to the care of critically ill adults.
(Copyright © 2022. Published by Elsevier España, S.L.U.)
Databáze: MEDLINE
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