Universität zu Köln

Garcia Borrega, J., Heindel, K., Kochanek, M., Warnke, C., Stemmler, J., von Bergwelt-Baildon, M., Liebregts, T. and Boell, B. (2021). The critically ill CAR T-cell patient Relevant toxicities, their management and challenges in critical care. Med. Klin.-Intensivmed Notfallmed., 116 (2). S. 121 - 129. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 2193-6226

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Abstract

Background CAR-T cell therapy has been implemented as clinical routine treatment option during the last decade. Despite beneficial outcomes in many patients severe side effects and toxicities are seen regularly that can compromise the treatment success. Methods Literature review: CAR T-cell therapy, toxicities and their management Results The cytokine release syndrome (CRS) and the immune effector cell-associated neurotoxicity syndrome (ICANS) are seen regularly after CAR T-cell treatment. CRS symptoms can range from mild flu-like symptoms to severe organ dysfunction requiring vasopressor therapy, mechanical ventilation and other intensive care support. ICANS symptoms usually develop later and can range from disorientation and aphasia to potentially life-threatening brain edema. IL-6 is a key factor in the pathophysiology of CRS. The pathophysiology of ICANS is not fully understood. The ASTCT consensus grading is recommended to stratify patients for different management options. An interdisciplinary team including hematologist, intensivist, neurologists and other specialties is needed to optimize the treatment. Discussion Severe and potentially life-threatening toxicities occur regularly after CAR T-cell therapy. Treatment strategies for CRS and ICANS still need to be evaluated prospectively. Due to the increasing number of patients treated with CAR T-cells the number of patients requiring temporary intensive care management due to CRS and ICANS is expected to increase during the next years.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Garcia Borrega, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Heindel, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Warnke, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Stemmler, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED von Bergwelt-Baildon, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Liebregts, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Boell, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579291
DOI:	10.1007/s00063-021-00780-w
Journal or Publication Title:	Med. Klin.-Intensivmed Notfallmed.
Volume:	116
Number:	2
Page Range:	S. 121 - 129
Date:	2021
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	2193-6226
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57929