Advance in EM
What is Car T cell therapy and implications for AED physician?
Dr KB Wong
Council Member, HKSEMS
CAR T cell therapy is a revolutionary new approach to cancer treatment that harnesses the power of the immune system to fight cancer. CARs are engineered synthetic receptors that function to redirect lymphocytes, most commonly T cells, to recognize and eliminate cells expressing a specific target antigen. (1). These modified T cells then target and destroy cancer cells, offering a potentially curative treatment option for patients with certain types of cancer.
Indications for CAR T therapy include certain types of leukemia and lymphoma that have not responded to other treatments, such as chemotherapy or stem cell transplantation. In particular, CAR T therapy has shown promising results in patients with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL). (2-4) and multiple myeloma (5)
However, CAR T therapy is not without its complications. The most common side effect of CAR T therapy is cytokine release syndrome (CRS). Clinically, the CRS can present with fevers, myalgias, hypotension and hypoxia. CRS occurs when the infused T cells activate the immune system, leading to the release of cytokines that can cause systemic inflammation. They can be mild and self-limiting, or progress in severity to high-grade fevers, hemodynamic compromise requiring vasopressor support, capillary leak, and severe hypoxia requiring ventilator support and multiple organ failure. (6) CRS median time of onset following CART infusion of 2–3 days. (7-9)
Another common, challenging side effect associated with CAR T-cell therapy is immune effector cell-associated neurotoxicity syndrome (ICANS), which can manifest as confusion, seizures, or other neurological symptoms. It is thought to be caused by the activation of T cells in the central nervous system, leading to inflammation and damage to brain cells.(10)
CRS can mimic other medical conditions such as sepsis, infection, or adrenal insufficiency, it would be important of A&E physician to raise our awareness. The treatment of CRS from CART depends on the severity of symptoms and can range from supportive care to more aggressive interventions. The use of antibiotics, steroid and tocilizumab (11) a monoclonal antibody that blocks the action of IL-6 are the mainstay treatment for severe case. Other medications that may be used include anakinra,(12) which blocks the action of IL-1, and siltuximab, (13) which blocks the action of IL-6.
Overall, CAR T therapy is a promising new treatment option for certain types of cancer, but it is important to be aware of the potential complications and to carefully monitor patients undergoing this treatment. As AED physician, we may encounter the complications of CART Therapy. We should resuscitate the patient as treatment of sepsis with cardiovascular support. The early use of immunotherapies, IL blocker would be considered with discussion with oncologists and ICU doctors.
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