Management of the Critically Ill Adult Chimeric Antigen Receptor-T Cell Therapy Patient: A Critical Care Perspective

Objectives: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. Data Sources: PubMed and Medline search of articles published from 2006 to date. Study Selection: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. Data Extraction: Not available . Data Synthesis: Not available. Conclusions: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment. Drs. Gutierrez, McEvoy, Mead, Stephens, and Pastores disclosed off-label product use of siltuximab for use in cytokine release syndrome and neurotoxicity related to chimeric antigen receptor T cells. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: cgutierrez4@mdanderson.org Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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