Background
- T cells are retrieved from a patient, genetically modified to add a chimeric antigen receptor (CAR) that is specific to the targetted cancer antigen, and reinfused into the patient following a short course of chemotherapy
- Used for relapsed or refractory B-cell acute lymphoblastic leukemia and high-grade B-cell lymphoma
| Product
|
Indications
|
Target Antigen
|
Survival
|
| Tisagenlecleucel
|
B-ALL and high-grade B-cell lymphoma
|
CD19
|
76% 1-year OS in B-ALL; 8.3 month median OS in B-cell lymphoma
|
| Axicabtagene ciloleucel
|
high-grade B-cell lymphoma
|
CD19
|
58% 18-month OS
|
| Brexucabtagene autoleucel
|
mantle cell lymphoma
|
CD19
|
83% 1-year OS
|
| Idecabtagene vicleucel
|
multiple myeloma
|
B-cell maturation antigen
|
11.8 month media PFS
|
| Lisocabtagene maraleucal
|
high-grade B-cell lymphoma
|
CD19
|
18.8 month median OS
|
Safety
Adverse Effects
- Prolonged cytopenias and B-cell hypoplasia (causing hypogammaglobulinemia that affects half to two-thirds of patients, some lasting up to 4 years)
- Loss of immunity to previous vaccinations
- Start revaccinating about 6 months after infusion
Cytokine Release Syndrome
- Caused by harmful immune system activation
- Fever is a defining feature, with hypotension and hypoxia in severe disease
- May also results in DIC, multiorgan failure, and death
- Treated with corticosteroids and tocilizumab, an IL-6 inhibitor
- Usually self-limited
Immune Effector Cell-Associated Neurotoxicity Syndrome
- ICANS
- Word-finding difficulty, aphasia, or confusion
- In severe disease, altered level of consciousness, motor impairment, and cerebral edema
- Treated with corticosteroids
- Most cases resolve
