SOHO 2026 | Community-based management of CAR-T and bispecific antibody-related CRS in B-cell lymphoma

These T-cell therapies, CAR T-cell therapy and bispecific antibodies, one of the main toxicities comes from the release of cytokines. And that’s a really important toxicity that needs to be managed. And we want these therapies to get out into where patients are, into the community. And so most of the trials, though, have been run at academic centers that can be very well set up, and patients can live really nearby to those centers to try and manage these toxicities when they occur. But out in the community, it’s a little bit different. Patients may be a bit further away from a hospital that has expertise in this management. There may not be dedicated expertise in the management at a place that’s right next to where they are. And so trying to think about how to allow these patients to get these therapies most safely is something that really involves a system. And I think that systems that are set up for success are the ones that are going to be able to do the best with these patients. Because sometimes these toxicities happen in the middle of the night and everyone has to be ready for when they happen. They’re not so complicated that they can’t be managed, but people need to understand them and be looking out for them. So the best ways to do that, I think, are for the oncologists themselves to have really good education for the patients. Patients are prepared and know what to do when these toxicities occur. Hospital systems are aware of these patients coming in and when they get seen in those hospitals, there’s a plan, an operating procedure on how to take care of them. And I think if those things can be done where there’s sort of a rapid ability to access care and everyone knows what to do, I think these toxicities can be really well managed in the community. But those systems have to be set up. And sometimes it’s easier in concentrated places like an academic center than it is across these practices or hospitals that are more distributed. And so patients are going to have cytokine release syndrome. And, you know, a little bit of cytokine release syndrome might be okay if a patient gets a fever. There are things that you can do. You can do prophylaxis. So you give therapies like steroids to try and prevent these from happening. Or some centers are giving patients pocket dexamethasone to take when they get these fevers and then see if they need care. All of these things can be organized and set up, but I think that the centers that are doing it need to be aware of these and plan for these eventualities is sort of the most important thing about these therapies.

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