Managing Persistent Diarrhea After Anti-BCMA CAR T

In this segment the panelists, Dr. Samir Parekh and Dr. Saurabh Mehandru, of Mount Sinai in New York, work through a patient case. Dr. Parekh presents a man in his sixties treated with anti-B-cell maturation antigen chimeric antigen receptor (CAR) T-cell therapy after several prior lines, who develops persistent non-bloody diarrhea, abdominal cramps, and rapid weight loss a few months after infusion, with negative stool studies and no relief from empiric loperamide. Dr. Mehandru calls this a classic presentation warranting immediate gastroenterology involvement, and outlines a twofold approach of excluding infection with multiplex polymerase chain reaction testing alongside culture, then looking for inflammation with fecal calprotectin, followed promptly by endoscopic evaluation with biopsies from representative segments, since involvement can be patchy. He urges clinicians to engage their pathologists directly, because the diagnostic clue is something missing rather than something added, namely a near-complete or complete absence of plasma cells, along with subtle epithelial apoptosis. Dr. Parekh emphasizes controlling infection before immunosuppression in an already immunocompromised patient, and Dr. Mehandru returns to the warning sign of symptoms coming roaring back as steroids are withdrawn.

This Insights Video was supported by Janssen Pharmaceutical. Content independently developed and published by OncLive.