Dr. Brody on Managing CAR T-Cell Therapy Toxicities in MCL

Joshua Brody, MD, director of the Lymphoma program at Icahn School of Medicine, Mount Sinai Hospital, discusses management strategies for the toxicities associated with CAR T-cell therapy in mantle cell lymphoma (MCL).

Cytokine release syndrome (CRS) and neurotoxicity are adverse effects associated with CAR T-cell therapy that can be managed through conservative therapy, observation, fluid hydration, and pressor drugs, Brody explains. Patients with severe CRS can receive steroids and tocilizumab (Actemra), an interleukin (IL)-6 receptor antibody. Novel therapies, such as the IL-1 receptor antagonist anakinra (Kineret), have also demonstrated efficacy in this setting.

Patients who develop neurotoxicity are treated with a similar strategy, says Brody, though he notes that the management protocol for CRS is further along than that of neurotoxicity.

Managing the risk of CRS and neurotoxicity before a patient begins treatment with CAR T-cell therapy is important, says Brody. Moreover, moving CAR T-cell therapy earlier in treatment to the third-line setting could be another option, as tumor bulk plays a key role in toxicity development. Debulking patients with effective therapies prior to CAR T-cell therapy may be key to utilizing the modalities earlier, concludes Brody.