Patients Need Careful Monitoring for CAR T-Cell Therapy Side Effects

Cytokine Release Syndrome and Neurotoxicity Are Among the Most Serious Risks

• Common side effects from CAR T-cell therapy include low blood counts, infections, and bleeding. More serious side effects, including cytokine release syndrome and neurotoxicity, have also been observed
• Patients may require prophylactic antibiotics
• CAR T-cell therapies can cause a heterogenous group of toxicities, and patients should be monitored closely by physicians and centers with expertise in administering CAR T-cell therapies and managing toxicities

Chimeric antigen receptor (CAR) T-cell therapy has become a major ally in the treatment of certain lymphomas and leukemias. However, this therapy is not without risks.

“CAR T-cell therapy is a very serious therapy and it does have some potentially serious side effects,” Dr. Julie Vose, chief of the Oncology/Hematology Division at University of Nebraska Medical Center, tells SurvivorNet Connect. The biggest risks are low blood counts, infection, and bleeding. Most patients need to be on antibiotics, get transfusions, and be monitored very carefully.

More worrisome, says Dr. Vose, are the more serious side effects. These include cytokine release syndrome (CRS), which produces symptoms like high fevers, muscle and bone aches, and low blood pressure. Neurotoxicity is another concern. “That’s a good thing if the lymphoma is in the brain, because it helps to fight the lymphoma, but it’s also a bad thing in that it can cause fluid retention or swelling of the brain and inflammation, and those can be very serious side effects,” Dr. Vose says.

Each type of CAR T-cell produces a different kind of side effect, and almost every patient who receives this treatment will have some kind of side effect, but most are treatable. “It’s the more serious, higher grades of this neurotoxicity and cytokine release syndrome that are more worrisome,” she adds. “That’s why this therapy has to be given in centers that know how to give it, have participated in the trials, and have very extensive experience in taking care of these types of patients.”