Joshua Brody, MD, discusses management strategies for the toxicities associated with CAR T-cell therapy in mantle cell lymphoma.
Joshua Brody, MD, director of the Lymphoma program at Icahn School of Medicine, Mount Sinai Hospital, discusses management strategies for the toxicities associated with CAR T-cell therapy in mantle cell lymphoma (MCL).
Cytokine release syndrome (CRS) and neurotoxicity are adverse effects associated with CAR T-cell therapy that can be managed through conservative therapy, observation, fluid hydration, and pressor drugs, Brody explains. Patients with severe CRS can receive steroids and tocilizumab (Actemra), an interleukin (IL)-6 receptor antibody. Novel therapies, such as the IL-1 receptor antagonist anakinra (Kineret), have also demonstrated efficacy in this setting.
Patients who develop neurotoxicity are treated with a similar strategy, says Brody, though he notes that the management protocol for CRS is further along than that of neurotoxicity.
Managing the risk of CRS and neurotoxicity before a patient begins treatment with CAR T-cell therapy is important, says Brody. Moreover, moving CAR T-cell therapy earlier in treatment to the third-line setting could be another option, as tumor bulk plays a key role in toxicity development. Debulking patients with effective therapies prior to CAR T-cell therapy may be key to utilizing the modalities earlier, concludes Brody.