Management of the critically ill adult chimeric antigen receptor-t cell therapy patient: A critical care perspective

Cristina Gutierrez, Colleen McEvoy, Elena Mead, Robert Stephens, Laveena Munshi, Michael E. Detsky, Stephen M. Pastores, Joseph L. Nates

Research output: Contribution to journalArticle

Abstract

Objectives: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. Data Sources: PubMed and Medline search of articles published from 2006 to date. Study Selection: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. Data Extraction: Not available. Data Synthesis: Not available. Conclusions: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.

Original languageEnglish (US)
Pages (from-to)1402-1410
Number of pages9
JournalCritical care medicine
Volume46
Issue number9
DOIs
StatePublished - Jan 1 2018

Fingerprint

Antigen Receptors
Critical Care
Cell- and Tissue-Based Therapy
Critical Illness
T-Cell Antigen Receptor
Multiple Organ Failure
Information Storage and Retrieval
Hematologic Neoplasms
Therapeutics
PubMed
Clinical Trials
Guidelines
Neoplasms

Keywords

  • Cerebral edema
  • Chimeric antigen receptor cell therapy
  • Cytokine release syndrome
  • Intensive care unit
  • Neurotoxicity
  • Seizures

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Management of the critically ill adult chimeric antigen receptor-t cell therapy patient : A critical care perspective. / Gutierrez, Cristina; McEvoy, Colleen; Mead, Elena; Stephens, Robert; Munshi, Laveena; Detsky, Michael E.; Pastores, Stephen M.; Nates, Joseph L.

In: Critical care medicine, Vol. 46, No. 9, 01.01.2018, p. 1402-1410.

Research output: Contribution to journalArticle

Gutierrez, Cristina ; McEvoy, Colleen ; Mead, Elena ; Stephens, Robert ; Munshi, Laveena ; Detsky, Michael E. ; Pastores, Stephen M. ; Nates, Joseph L. / Management of the critically ill adult chimeric antigen receptor-t cell therapy patient : A critical care perspective. In: Critical care medicine. 2018 ; Vol. 46, No. 9. pp. 1402-1410.
@article{bfe3c14f0c6b42779d8ff6c44ba1335d,
title = "Management of the critically ill adult chimeric antigen receptor-t cell therapy patient: A critical care perspective",
abstract = "Objectives: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. Data Sources: PubMed and Medline search of articles published from 2006 to date. Study Selection: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. Data Extraction: Not available. Data Synthesis: Not available. Conclusions: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.",
keywords = "Cerebral edema, Chimeric antigen receptor cell therapy, Cytokine release syndrome, Intensive care unit, Neurotoxicity, Seizures",
author = "Cristina Gutierrez and Colleen McEvoy and Elena Mead and Robert Stephens and Laveena Munshi and Detsky, {Michael E.} and Pastores, {Stephen M.} and Nates, {Joseph L.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/CCM.0000000000003258",
language = "English (US)",
volume = "46",
pages = "1402--1410",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Management of the critically ill adult chimeric antigen receptor-t cell therapy patient

T2 - A critical care perspective

AU - Gutierrez, Cristina

AU - McEvoy, Colleen

AU - Mead, Elena

AU - Stephens, Robert

AU - Munshi, Laveena

AU - Detsky, Michael E.

AU - Pastores, Stephen M.

AU - Nates, Joseph L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. Data Sources: PubMed and Medline search of articles published from 2006 to date. Study Selection: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. Data Extraction: Not available. Data Synthesis: Not available. Conclusions: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.

AB - Objectives: Chimeric antigen receptor T-cell therapy, a type of immune effector therapy for cancer, has demonstrated encouraging results in clinical trials for the treatment of patients with refractory hematologic malignancies. Nevertheless, there are toxicities specific to these treatments that, if not recognized and treated appropriately, can lead to multiple organ failure and death. This article is a comprehensive review of the available literature and provides, from a critical care perspective, recommendations by experienced intensivists in the care of critically ill adult chimeric antigen receptor T-cell patients. Data Sources: PubMed and Medline search of articles published from 2006 to date. Study Selection: Clinical studies, reviews, or guidelines were selected and reviewed by the authors. Data Extraction: Not available. Data Synthesis: Not available. Conclusions: Until modifications in chimeric antigen receptor T-cell therapy decrease their toxicities, the intensivist will play a leading role in the management of critically ill chimeric antigen receptor T-cell patients. As this novel immunotherapeutic approach becomes widely available, all critical care clinicians need to be familiar with the recognition and management of complications associated with this treatment.

KW - Cerebral edema

KW - Chimeric antigen receptor cell therapy

KW - Cytokine release syndrome

KW - Intensive care unit

KW - Neurotoxicity

KW - Seizures

UR - http://www.scopus.com/inward/record.url?scp=85056448900&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056448900&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000003258

DO - 10.1097/CCM.0000000000003258

M3 - Article

C2 - 29939878

AN - SCOPUS:85056448900

VL - 46

SP - 1402

EP - 1410

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 9

ER -