Key Points
• The authors of this article are from the National Cancer institute. They noted that although cytokine release syndrome (CRS) and neurological toxicity are widespread barriers to CAR T-cell therapy, this therapy is remarkably beneficial to patients. They provide treatment guidance and guidance on the management of toxicities.
• The authors noted that although the guidelines for the supportive care of hospitalized patients post CAR T-cell infusion are similar across treatment centers, variability exists with respect to the preference of administering cell products in an inpatient or outpatient setting.
• “We proceed with CAR T-cell therapy only for patients with close to normal end organ function, including pulmonary, renal, hepatic function, and cardiac function, with a requirement for a normal cardiac ejection fraction, as previously described, due to concerns about patient safety,” the authors wrote. “The larger published clinical trials of the FDA-approved CAR T-cell products have in large part excluded patients with baseline active CNS involvement with malignancy, such that the safety of these products for patients with CNS malignancy has not been fully explored.”
• “In terms of patient monitoring, we hospitalize patients for monitoring prior to their CAR T-cell infusion and monitor hospitalized patients for at least 9 days following cell infusion,” they wrote. “When patients are discharged from the inpatient service, they continue monitoring for toxicity on an outpatient basis. Patients are instructed to monitor their temperature twice a day and present for immediate evaluation if they have a fever, as described above. Patients are counseled to monitor for neurologic toxicity, and patients are mandated to have a caregiver to assist in monitoring, and to assist in seeking medical attention for the patient if any encephalopathy develops.”

A nice but already dated review of car T cell landscape with a relevant focus on toxicity management