Chimeric antigen receptor T-cell therapy: Difference between revisions
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|Idecabtagene vicleucel |
|Idecabtagene vicleucel |
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|multiple myeloma |
|multiple myeloma |
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| + | |B-cell maturation antigen |
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| − | |BCMA |
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|11.8 month media PFS |
|11.8 month media PFS |
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|18.8 month median OS |
|18.8 month median OS |
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| + | == Safety == |
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| + | |||
| + | === Adverse Effects === |
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| + | |||
| + | * Prolonged cytopenias and B-cell hypoplasia (causing [[hypogammaglobulinemia]] that affects half to two-thirds of patients, some lasting up to 4 years) |
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| + | * Loss of immunity to previous vaccinations |
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| + | ** Start revaccinating about 6 months after infusion |
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| + | |||
| + | === Cytokine Release Syndrome === |
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| + | |||
| + | * Caused by harmful immune system activation |
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| + | * Fever is a defining feature, with hypotension and hypoxia in severe disease |
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| + | ** Often mimics sepsis |
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| + | * May also results in [[DIC]], multiorgan failure, and death |
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| + | * Treated with corticosteroids and [[tocilizumab]], an IL-6 inhibitor |
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| + | * Usually self-limited |
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| + | |||
| + | === Immune Effector Cell-Associated Neurotoxicity Syndrome === |
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| + | |||
| + | * ICANS |
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| + | * Word-finding difficulty, aphasia, or confusion |
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| + | * In severe disease, altered level of consciousness, motor impairment, and cerebral edema |
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| + | * Treated with corticosteroids |
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| + | * Most cases resolve |
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[[Category:Hematology]] |
[[Category:Hematology]] |
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[[Category:Oncology]] |
[[Category:Oncology]] |
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Latest revision as of 17:05, 1 March 2024
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
