Dr. Braunschweig on Mitigating the Toxicities of CAR T-Cell Therapy in Lymphoma

Ira Braunschweig, MD, director, Stem Cell Transplant Program, clinical program director, Hematologic Malignancies, Montefiore Medical Center, associate professor, Department of Medicine (Oncology), Albert Einstein College of Medicine, discusses mitigating ​the toxicities that are associated with CAR T-cell therapy in lymphoma.

Despite the encouraging responses that have been observed with CAR T-cell therapy in lymphoma, several toxicities ​can arise with these products.

However, data suggests that ​administration of the immunosuppressive agent tocilizumab (Actemra) at fever onset could help mitigate some of the adverse effects, such as cytokine release syndrome, says Braunschweig. Notably, this agent will not abrogate the anti-tumor effect of the cellular therapy. 

Furthermore, ​data have shown that ​early steroid use may mitigate neurotoxicity, Braunschweig adds. ​Using steroids, which kill lymphocytes, may seem counterintuitive as CAR T cells are lymphocytes. However,​ steroids appear to mitigate neurotoxicity without alter​ing the mechanism of​ action of the​ CAR T-cell therapy.

Utilizing steroids early may eliminate the risk of confusion or, in severe cases, coma, among patients with lymphoma who receive CAR T-cell therapy, Braunschweig concludes.