Review Article: Immune Effector Cell-Mediated Enterocolitis Following CAR-T Cell Therapy-Clinical Features,...

Area of Science:

• Immunology
• Gastroenterology
• Oncology

Background:

• Chimeric antigen receptor T-cell (CAR-T) therapy is a revolutionary treatment for hematologic malignancies, expanding into autoimmune diseases.
• CAR-T therapy is associated with immune-related toxicities, including cytokine release syndrome and neurotoxicity.
• Immune effector cell-mediated enterocolitis (IEC-EC) is a rare gastrointestinal mucosal inflammation linked to CAR-T therapy.

Purpose of the Study:

• To review the mechanism of CAR-T therapy.
• To detail the epidemiology, pathophysiology, clinical, endoscopic, and histopathologic features of IEC-EC.
• To outline the management strategies for IEC-EC.

Main Methods:

• Comprehensive synthesis of all reported case series in the literature.
• State-of-the-art review of current knowledge on IEC-EC.

Main Results:

• IEC-EC occurs in up to 6% of patients, typically after B cell maturation antigen-targeted CAR-T therapy.
• Presents with severe diarrhea, malabsorption, poor treatment response, and dire prognosis.
• Management involves early diagnosis, supportive care, infection treatment, and step-up pharmacotherapy, including biologics and small molecules.

Conclusions:

• Clinicians must maintain high vigilance for IEC-EC in patients with gastrointestinal symptoms post-CAR-T treatment.
• Early recognition and multidisciplinary treatment are essential for potentially improving patient outcomes.