EBMT 2024 | Mitigating the potential complications of CAR-T therapy: important supportive care measures
Sridhar Chaganti, MD, PhD, MRCP, FRCPath, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, summarizes measures that can be taken to reduce non-relapse mortality (NRM) in patients receiving CAR-T therapy. Of the supportive care strategies that exist, Dr Chaganti suggests that enhanced immune monitoring, administering antibody titers, and immunoglobulin replacement therapies are crucial for the long-term management of patients. This interview took place at the 50th Annual Meeting of the EBMT in Glasgow, Scotland.
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Transcript (edited for clarity)
So we have learned a lot about managing patients with CAR T-cell therapy. I was referring to measures we can take, prophylactic measures that we can take to reduce the risk of some of the acute toxicities like CRS and ICANS. And we have seen data with itacitinib in this meeting, we have seen previously published data with prophylactic dexamethasone or prophylactic anakinra. But I really think the more important aspect of management of patients supportive care really is maybe a bit down the line...
So we have learned a lot about managing patients with CAR T-cell therapy. I was referring to measures we can take, prophylactic measures that we can take to reduce the risk of some of the acute toxicities like CRS and ICANS. And we have seen data with itacitinib in this meeting, we have seen previously published data with prophylactic dexamethasone or prophylactic anakinra. But I really think the more important aspect of management of patients supportive care really is maybe a bit down the line. And we have seen there is a significant risk of non relapse mortality in our CAR-T patients because they have persistent B-cell aplasia, hypogammaglobulinemia, and there is an increased risk of infections. So enhanced immune monitoring, you know monitoring for maybe response to vaccinations, their antibody titers, considering them for immunoglobulin replacement therapy. This will form a very important strategy of managing these patients over the months after CAR T-cell therapy to try and reduce the risk of non relapsed mortality that we have seen in this treatment.
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