[Management of cytokine release syndrome and macrophage activation syndrome following CAR-T cell therapy: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].
Fiche publication
Date publication
décembre 2021
Journal
Bulletin du cancer
Auteurs
Membres identifiés du Cancéropôle Est :
Dr POCHON Cécile
Tous les auteurs :
Tudesq JJ, Yakoub-Agha M, Bay JO, Courbon C, Paul F, Picard M, Pochon C, Sterin A, Vicente C, Canet E, Yakoub-Agha I, Moreau AS
Lien Pubmed
Résumé
The use of chimeric antigen receptor T cells (CAR-T) has increased since their approval in the treatment of several relapsed/refractory B cell malignancies. The management of their specific toxicities, such as cytokine release syndrome (CRS), tends to be better understood and well-defined. During the twelfth edition of practice harmonization workshops of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), a working group focused its work on the management of patients developing CRS following CAR-T cell therapy. A special chapter has been allocated to macrophage activation syndrome (MAS), a rare but life-threatening complication post-CAR-T. In addition to symptomatic measures and preemptive broad-spectrum antibiotics, immunomodulators such as tocilizumab and corticosteroids remain the corner stone for the treatment of CRS. Tocilizumab/corticosteroids-resistant CRS associated with haemophagocytosis markers (spleen and liver enlargement, hyperferritinaemia>10,000ng/mL, hypofibrinogenemia…) should direct the diagnosis towards an overlapping CRS/MAS. An adapted treatment will be based on high-dose IV anakinra and corticosteroids and chemotherapy with etoposide at late refractory stages. These complications and others delignate the need of close collaboration with an intensive care unit.
Mots clés
Anakinra, CAR-T cell, CAR-T cells, Corticosteroids, Corticostéroïdes, Cytokine release syndrome (CRS), Etoposide, Haemophagocytosis, Syndrome de relargage cytokinique (CRS), Syndrome d’activation macrophagique (SAM), Tocilizumab, Étoposide
Référence
Bull Cancer. 2021 Dec 8;: