Management of cytokine release syndrome related to CAR-T cell therapy
Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated....
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| Veröffentlicht in: | Frontiers of medicine 2019-10, Vol.13 (5), p.610-617 |
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| creator | Chen, Hongli Wang, Fangxia Zhang, Pengyu Zhang, Yilin Chen, Yinxia Fan, Xiaohu Cao, Xingmei Liu, Jie Yang, Yun Wang, Baiyan Lei, Bo Gu, Liufang Bai, Ju Wei, Lili Zhang, Ruili Zhuang, Qiuchuan Zhang, Wanggang Zhao, Wanhong He, Aili |
| description | Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer. |
| doi_str_mv | 10.1007/s11684-019-0714-8 |
| format | Article |
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Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.</description><identifier>ISSN: 2095-0217</identifier><identifier>EISSN: 2095-0225</identifier><identifier>DOI: 10.1007/s11684-019-0714-8</identifier><identifier>PMID: 31571160</identifier><language>eng</language><publisher>Beijing: Higher Education Press</publisher><subject>Adolescent ; Antibodies, Monoclonal, Humanized - therapeutic use ; Antigens ; Blood ; Cancer therapies ; Chemotherapy ; chimeric antigen receptor T cell ; Clinical trials ; cytokine release syndrome ; Cytokine Release Syndrome - drug therapy ; Cytokine Release Syndrome - etiology ; Cytokines ; Cytokines - immunology ; Dexamethasone - therapeutic use ; Enrollments ; FDA approval ; Humans ; Immunosuppressive agents ; Immunotherapy ; Immunotherapy, Adoptive - adverse effects ; Leukemia ; Lymphocytes ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Monoclonal antibodies ; Multiple myeloma ; Multiple Myeloma - complications ; Patients ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications ; Quality of Life ; Receptors, Antigen, T-Cell - immunology ; Receptors, Chimeric Antigen - immunology ; Research Article ; Respiratory failure ; tocilizumab ; Young Adult</subject><ispartof>Frontiers of medicine, 2019-10, Vol.13 (5), p.610-617</ispartof><rights>Copyright reserved, 2019, Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature</rights><rights>Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Frontiers of Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><rights>Copyright Springer Nature B.V. 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-8415e99c01e4edfc34ca98ff10ac4e848b15393628cf0b0fef606e685e2cb2103</citedby><cites>FETCH-LOGICAL-c449t-8415e99c01e4edfc34ca98ff10ac4e848b15393628cf0b0fef606e685e2cb2103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11684-019-0714-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11684-019-0714-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31571160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Hongli</creatorcontrib><creatorcontrib>Wang, Fangxia</creatorcontrib><creatorcontrib>Zhang, Pengyu</creatorcontrib><creatorcontrib>Zhang, Yilin</creatorcontrib><creatorcontrib>Chen, Yinxia</creatorcontrib><creatorcontrib>Fan, Xiaohu</creatorcontrib><creatorcontrib>Cao, Xingmei</creatorcontrib><creatorcontrib>Liu, Jie</creatorcontrib><creatorcontrib>Yang, Yun</creatorcontrib><creatorcontrib>Wang, Baiyan</creatorcontrib><creatorcontrib>Lei, Bo</creatorcontrib><creatorcontrib>Gu, Liufang</creatorcontrib><creatorcontrib>Bai, Ju</creatorcontrib><creatorcontrib>Wei, Lili</creatorcontrib><creatorcontrib>Zhang, Ruili</creatorcontrib><creatorcontrib>Zhuang, Qiuchuan</creatorcontrib><creatorcontrib>Zhang, Wanggang</creatorcontrib><creatorcontrib>Zhao, Wanhong</creatorcontrib><creatorcontrib>He, Aili</creatorcontrib><title>Management of cytokine release syndrome related to CAR-T cell therapy</title><title>Frontiers of medicine</title><addtitle>Front. Med</addtitle><addtitle>Front Med</addtitle><description>Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.</description><subject>Adolescent</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Antigens</subject><subject>Blood</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>chimeric antigen receptor T cell</subject><subject>Clinical trials</subject><subject>cytokine release syndrome</subject><subject>Cytokine Release Syndrome - drug therapy</subject><subject>Cytokine Release Syndrome - etiology</subject><subject>Cytokines</subject><subject>Cytokines - immunology</subject><subject>Dexamethasone - therapeutic use</subject><subject>Enrollments</subject><subject>FDA approval</subject><subject>Humans</subject><subject>Immunosuppressive agents</subject><subject>Immunotherapy</subject><subject>Immunotherapy, Adoptive - adverse effects</subject><subject>Leukemia</subject><subject>Lymphocytes</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies</subject><subject>Multiple myeloma</subject><subject>Multiple Myeloma - complications</subject><subject>Patients</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</subject><subject>Quality of Life</subject><subject>Receptors, Antigen, T-Cell - immunology</subject><subject>Receptors, Chimeric Antigen - immunology</subject><subject>Research Article</subject><subject>Respiratory failure</subject><subject>tocilizumab</subject><subject>Young Adult</subject><issn>2095-0217</issn><issn>2095-0225</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtLxDAUhYMoKuoPcCMFN26qN482yVIGX6AIouuQSW_G6rQZk85i_r0Z6wNcTDYJyXfOvbmHkGMK5xRAXiRKayVKoLoESUWptsg-A12VwFi1_Xumco8cpfQGeYmaSq13yR6nlcxy2CdXD7a3M-ywH4rgC7cawnvbYxFxjjZhkVZ9E0P3dWEHbIohFJPLp_K5cDifF8MrRrtYHZIdb-cJj773A_JyffU8uS3vH2_uJpf3pRNCD6UStEKtHVAU2HjHhbNaeU_BOoFKqCmtuOY1U87DFDz6GmqsVYXMTRkFfkDORt9FDB9LTIPp2rRuxPYYlskwprWU-WM6o6f_0LewjH3uzjAONROSS76Ryl6cVQxEpuhIuRhSiujNIradjStDwazDMGMYJodh1mEYlTUn387LaYfNr-Jn9BlgI5DyUz_D-Fd6k6saRa_tLI8em0XElIyPoR9ajJukn_1go50</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Chen, Hongli</creator><creator>Wang, Fangxia</creator><creator>Zhang, Pengyu</creator><creator>Zhang, Yilin</creator><creator>Chen, Yinxia</creator><creator>Fan, Xiaohu</creator><creator>Cao, Xingmei</creator><creator>Liu, Jie</creator><creator>Yang, Yun</creator><creator>Wang, Baiyan</creator><creator>Lei, Bo</creator><creator>Gu, Liufang</creator><creator>Bai, Ju</creator><creator>Wei, Lili</creator><creator>Zhang, Ruili</creator><creator>Zhuang, Qiuchuan</creator><creator>Zhang, Wanggang</creator><creator>Zhao, Wanhong</creator><creator>He, Aili</creator><general>Higher Education Press</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20191001</creationdate><title>Management of cytokine release syndrome related to CAR-T cell therapy</title><author>Chen, Hongli ; Wang, Fangxia ; Zhang, Pengyu ; Zhang, Yilin ; Chen, Yinxia ; Fan, Xiaohu ; Cao, Xingmei ; Liu, Jie ; Yang, Yun ; Wang, Baiyan ; Lei, Bo ; Gu, Liufang ; Bai, Ju ; Wei, Lili ; Zhang, Ruili ; Zhuang, Qiuchuan ; Zhang, Wanggang ; Zhao, Wanhong ; He, Aili</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c449t-8415e99c01e4edfc34ca98ff10ac4e848b15393628cf0b0fef606e685e2cb2103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Antigens</topic><topic>Blood</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>chimeric antigen receptor T cell</topic><topic>Clinical trials</topic><topic>cytokine release syndrome</topic><topic>Cytokine Release Syndrome - drug therapy</topic><topic>Cytokine Release Syndrome - etiology</topic><topic>Cytokines</topic><topic>Cytokines - immunology</topic><topic>Dexamethasone - therapeutic use</topic><topic>Enrollments</topic><topic>FDA approval</topic><topic>Humans</topic><topic>Immunosuppressive agents</topic><topic>Immunotherapy</topic><topic>Immunotherapy, Adoptive - adverse effects</topic><topic>Leukemia</topic><topic>Lymphocytes</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies</topic><topic>Multiple myeloma</topic><topic>Multiple Myeloma - complications</topic><topic>Patients</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications</topic><topic>Quality of Life</topic><topic>Receptors, Antigen, T-Cell - immunology</topic><topic>Receptors, Chimeric Antigen - immunology</topic><topic>Research Article</topic><topic>Respiratory failure</topic><topic>tocilizumab</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Hongli</creatorcontrib><creatorcontrib>Wang, Fangxia</creatorcontrib><creatorcontrib>Zhang, Pengyu</creatorcontrib><creatorcontrib>Zhang, Yilin</creatorcontrib><creatorcontrib>Chen, Yinxia</creatorcontrib><creatorcontrib>Fan, Xiaohu</creatorcontrib><creatorcontrib>Cao, Xingmei</creatorcontrib><creatorcontrib>Liu, Jie</creatorcontrib><creatorcontrib>Yang, Yun</creatorcontrib><creatorcontrib>Wang, Baiyan</creatorcontrib><creatorcontrib>Lei, Bo</creatorcontrib><creatorcontrib>Gu, Liufang</creatorcontrib><creatorcontrib>Bai, Ju</creatorcontrib><creatorcontrib>Wei, Lili</creatorcontrib><creatorcontrib>Zhang, Ruili</creatorcontrib><creatorcontrib>Zhuang, Qiuchuan</creatorcontrib><creatorcontrib>Zhang, Wanggang</creatorcontrib><creatorcontrib>Zhao, Wanhong</creatorcontrib><creatorcontrib>He, Aili</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Frontiers of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Hongli</au><au>Wang, Fangxia</au><au>Zhang, Pengyu</au><au>Zhang, Yilin</au><au>Chen, Yinxia</au><au>Fan, Xiaohu</au><au>Cao, Xingmei</au><au>Liu, Jie</au><au>Yang, Yun</au><au>Wang, Baiyan</au><au>Lei, Bo</au><au>Gu, Liufang</au><au>Bai, Ju</au><au>Wei, Lili</au><au>Zhang, Ruili</au><au>Zhuang, Qiuchuan</au><au>Zhang, Wanggang</au><au>Zhao, Wanhong</au><au>He, Aili</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of cytokine release syndrome related to CAR-T cell therapy</atitle><jtitle>Frontiers of medicine</jtitle><stitle>Front. Med</stitle><addtitle>Front Med</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>13</volume><issue>5</issue><spage>610</spage><epage>617</epage><pages>610-617</pages><issn>2095-0217</issn><eissn>2095-0225</eissn><abstract>Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.</abstract><cop>Beijing</cop><pub>Higher Education Press</pub><pmid>31571160</pmid><doi>10.1007/s11684-019-0714-8</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Antibodies, Monoclonal, Humanized - therapeutic use Antigens Blood Cancer therapies Chemotherapy chimeric antigen receptor T cell Clinical trials cytokine release syndrome Cytokine Release Syndrome - drug therapy Cytokine Release Syndrome - etiology Cytokines Cytokines - immunology Dexamethasone - therapeutic use Enrollments FDA approval Humans Immunosuppressive agents Immunotherapy Immunotherapy, Adoptive - adverse effects Leukemia Lymphocytes Male Medical prognosis Medicine Medicine & Public Health Middle Aged Monoclonal antibodies Multiple myeloma Multiple Myeloma - complications Patients Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications Quality of Life Receptors, Antigen, T-Cell - immunology Receptors, Chimeric Antigen - immunology Research Article Respiratory failure tocilizumab Young Adult |
| title | Management of cytokine release syndrome related to CAR-T cell therapy |
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