Dr. Sehgal on Managing CRS and Neurotoxicity From CAR T-Cell Therapy

Alison R. Sehgal, MD, assistant professor of medicine, hematologist/medical oncologist, University of Pittsburgh School of Medicine, UPMC Hillman Cancer Center, discusses ways to manage cytokine release syndrome (CRS) and neurotoxicity associated with CAR T-cell therapy.

The management strategies for CRS and neurotoxicity depend on the severity of the syndromes, says Sehgal. With regard to CRS experienced with axicabtagene-ciloleucel (axi-cel; Yescarta), most patients get a fever, which is classified as grade 1. These patients can be managed supportively most of the time—often with Tylenol, fluids, or other antipyretics. If the fever continues, or if it escalates to hypotension or organ dysfunction—particularly pulmonary dysfunction—then an interleukin-6 receptor blocker is often used.

If a patient develops CRS that is refractory to supportive care and tocilizumab (Actemra), many centers, in accordance with real-world data, rely on steroids to combat the toxicity. Tocilizumab does not have a role in the management of neurologic toxicity unless there is concurrent CRS. Therefore, patients who develop more severe neurologic toxicity should be moved swiftly to steroids, concludes Sehgal.