Recognizing and Grading CAR T-Cell Toxicities: An Advanced Practitioner Perspective.

Area of Science:

• Oncology
• Immunotherapy
• Cellular Therapy

Background:

• Chimeric antigen receptor (CAR) T-cell therapy has revolutionized B-cell malignancy treatment.
• Expansion of CAR T-cell therapy to new targets and solid tumors is anticipated.
• CAR T-cell therapy presents unique, potentially fatal toxicities like cytokine release syndrome and neurotoxicity.

Purpose of the Study:

• To highlight the evolving understanding of CAR T-cell therapy toxicities.
• To emphasize the critical role of advanced practice providers in managing these toxicities.
• To underscore the need for institutional adaptation in providing CAR T-cell therapy.

Main Methods:

• Review of current literature and clinical practice guidelines for CAR T-cell therapy.
• Analysis of toxicity profiles, including cytokine release syndrome and neurotoxicity.
• Examination of institutional infrastructure and staffing models for safe patient care.

Main Results:

• CAR T-cell therapy demonstrates significant efficacy in relapsed/refractory B-cell malignancies.
• Cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are key adverse events.
• Effective management requires multidisciplinary collaboration and provider expertise.

Conclusions:

• Managing CAR T-cell therapy toxicities is a dynamic and evolving process.
• Advanced practice providers are integral to the multidisciplinary team for patient care.
• Institutions must adapt to safely administer and monitor patients receiving CAR T-cell therapy.