Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline

Bianca D Santomasso; Loretta J Nastoupil; Sherry Adkins; Christina Lacchetti; Bryan J Schneider; Milan Anadkat; Michael B Atkins; Kelly J Brassil; Jeffrey M Caterino; Ian Chau; Marianne J Davies; Marc S Ernstoff; Leslie Fecher; Pauline Funchain; Ishmael Jaiyesimi; Jennifer S Mammen; Jarushka Naidoo; Aung Naing; Tanyanika Phillips; Laura D Porter; Cristina A Reichner; Carole Seigel; Jung-Min Song; Alexander Spira; Maria Suarez-Almazor; Umang Swami; John A Thompson; Praveen Vikas; Yinghong Wang; Jeffrey S Weber; Kathryn Bollin; Monalisa Ghosh

doi:10.1200/JCO.21.01992

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Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline

Journal article

Open access

Peer reviewed

Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline

Bianca D Santomasso, Loretta J Nastoupil, Sherry Adkins, Christina Lacchetti, Bryan J Schneider, Milan Anadkat, Michael B Atkins, Kelly J Brassil, Jeffrey M Caterino, Ian Chau, …

Journal of clinical oncology, Vol.39(35), pp.3978-3992

12/10/2021

DOI: 10.1200/JCO.21.01992

PMID: 34724386

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Abstract

To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell therapy. A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021. The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.

Cytokine Release Syndrome - etiology

Cytokine Release Syndrome - pathology

Cytokine Release Syndrome - therapy

Disease Management

Drug-Related Side Effects and Adverse Reactions - etiology

Drug-Related Side Effects and Adverse Reactions - pathology

Drug-Related Side Effects and Adverse Reactions - therapy

Humans

Immunotherapy, Adoptive - adverse effects

Neoplasms - immunology

Neoplasms - pathology

Neoplasms - therapy

Practice Guidelines as Topic - standards

Prognosis

Details

Title: Subtitle: Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline
Creators: Bianca D Santomasso - Memorial Sloan Kettering Cancer Center
Loretta J Nastoupil - The University of Texas MD Anderson Cancer Center
Sherry Adkins - The University of Texas MD Anderson Cancer Center
Christina Lacchetti - American Society of Clinical Oncology
Bryan J Schneider - University of Michigan
Milan Anadkat - Washington University in St. Louis
Michael B Atkins - Georgetown University
Kelly J Brassil - The University of Texas MD Anderson Cancer Center
Jeffrey M Caterino - The Ohio State University Wexner Medical Center
Ian Chau - Royal Marsden Hospital
Marianne J Davies - Smilow Cancer Hospital
Marc S Ernstoff - National Cancer Institute
Leslie Fecher - University of Michigan
Pauline Funchain - Cleveland Clinic
Ishmael Jaiyesimi - Cancer Care Associates PC, Royal Oak, MI.
Jennifer S Mammen - Johns Hopkins University
Jarushka Naidoo - Sidney Kimmel Comprehensive Cancer Center
Aung Naing - The University of Texas MD Anderson Cancer Center
Tanyanika Phillips - City Of Hope National Medical Center
Laura D Porter - Patient Advocate, Colon Cancer Alliance, Washington, DC
Cristina A Reichner - Georgetown University
Carole Seigel - Patient Advocate, MGH Cancer Center, Boston, MA.
Jung-Min Song - Cleveland Clinic
Alexander Spira - Virginia Cancer Specialists
Maria Suarez-Almazor - The University of Texas MD Anderson Cancer Center
Umang Swami - Huntsman Cancer Institute
John A Thompson - Seattle Cancer Care Alliance
Praveen Vikas - University of Iowa
Yinghong Wang - The University of Texas MD Anderson Cancer Center
Jeffrey S Weber - NYU Langone Health
Kathryn Bollin - Scripps MD Anderson Cancer Center
Monalisa Ghosh - University of Michigan
Resource Type: Journal article
Publication Details: Journal of clinical oncology, Vol.39(35), pp.3978-3992
DOI: 10.1200/JCO.21.01992
PMID: 34724386
NLM abbreviation: J Clin Oncol
ISSN: 0732-183X
eISSN: 1527-7755
Language: English
Date published: 12/10/2021
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984359807902771

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