Severe CRS management in CAR-T cell therapy

Abstract

The prognosis of relapsed/refractory acute lymphoblastic leukemia remains poor. Recently developed CAR-T cell therapy is one of the promising new therapies because it provides a high response rate in patients with this leukemia. However, unique side effects such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) can happen and become potentially very severe. Massive cytokine production by activated CAR-T cells is postulated to be the cause, but this needs more research to better cope with it. On the basis of our experience in the ELIANA trial, we discuss the flow of CAR-T therapy, the main clinical course, and the management of CRS.