View source for Chimeric antigen receptor T-cell therapy

== 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]]

{| class="wikitable sortable"
!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

[[Category:Hematology]]
[[Category:Oncology]]