Identifying and managing CAR T-cell-mediated toxicities: on behalf of an Italian CAR-T multidisciplinary team
| Autor: | Virginia Naso, Rosangela Surace, Frank Cirrone, Said Al Sayyad, Bruno Martino, Francesco Curmaci, Giuseppe Scappatura, Renza Monteleone, Giuseppa Cusumano, Demetrio Labate, Barbara Loteta, Maria Pellicano, Vincenzo Amalfi, Filippo Antonio Canale, Domenico Quattrone, Umberto Aguglia, Jessyca Germano, Caterina Stelitano, Viviana Loddo, Antonella Morabito, Giuseppe Console, Letteria Russo, Vittoria Borzumati, Massimo Martino, Antonella Pontari, Antonio Maria Rossetti, Alfonso Trimarchi, Claudio Franzutti, Lucrezia Imbalzano, Giulia Pucci, Sebastiano Macheda, Caterina Alati, Maria Altomonte, Luciano Arcudi, Cristina Sanguedolce, Antonio Moschella, Benedetto Bruno, Vincenzo Dattola, Carmelo Massimiliano Rao, Anna Ferreri, Tiziana Moscato, Caterina Gattuso, Giuseppe Irrera, Maria Teresa Florenzano |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
T-Lymphocytes Adoptive Clinical Biochemistry Multidisciplinary team Immunotherapy Adoptive ICANS chemistry.chemical_compound Tocilizumab Receptors Drug Discovery medicine Tumor Microenvironment neurological toxicity Humans Intensive care medicine Pharmacology Patient Care Team Tumor microenvironment Receptors Chimeric Antigen business.industry Mechanism (biology) biomarkers toxicity Chimeric Antigen Chimeric antigen receptor Blockade chemistry CAR T therapy Hematologic Neoplasms Toxicity Immunotherapy Car t cells business |
| Zdroj: | Expert opinion on biological therapy. 22(3) |
| ISSN: | 1744-7682 |
| Popis: | INTRODUCTION Chimeric antigen receptor (CAR)-T-cell therapy is a new treatment for patients with hematologic malignancies in which other therapies have failed. AREAS COVERED The review provides an overview for recognizing and managing the most acute toxicities related to CAR-T cells. EXPERT OPINION The development of immune-mediated toxicities is a common challenge of CAR-T therapy. The mechanism that determines this toxicity is still unclear, although an unfavorable tumor microenvironment and a pro-inflammatory state put patients at risk. The monitoring, diagnosis, and treatment of post-CAR-T toxicities must be determined and based on international guidelines and internal clinical practice. It is urgent to identify biomarkers that can identify patients at greater risk of developing complications. The adoption of consistent grading criteria is necessary to improve toxicity management strategies continually. The first-line therapy consists of supportive care and treatment with tocilizumab or corticosteroids. An early start of cytokine blockade therapies could mitigate toxicity. The plan will include cytokine release prophylaxis, a risk-adapted treatment, prevention of on-target/off-tumor effect, and a switch on/off CAR-T approach. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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