Chimeric antigen receptor T-cell therapy
From IDWiki
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
- Often mimics sepsis
- 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
