TY - JOUR
T1 - The chimeric antigen receptor-intensive care unit (CAR-ICU) initiative
T2 - Surveying intensive care unit practices in the management of CAR T-cell associated toxicities
AU - Gutierrez, Cristina
AU - Brown, Anne Rain T.
AU - Herr, Megan M.
AU - Kadri, Sameer S.
AU - Hill, Brian
AU - Rajendram, Prabalini
AU - Duggal, Abhijit
AU - Turtle, Cameron J.
AU - Patel, Kevin
AU - Lin, Yi
AU - May, Heather P.
AU - Gallo de Moraes, Alice
AU - Maus, Marcela V.
AU - Frigault, Mathew J.
AU - Brudno, Jennifer N.
AU - Athale, Janhavi
AU - Shah, Nirali N.
AU - Kochenderfer, James N.
AU - Dharshan, Ananda
AU - Beitinjaneh, Amer
AU - Arias, Alejandro S.
AU - McEvoy, Colleen
AU - Mead, Elena
AU - Stephens, R. Scott
AU - Nates, Joseph L.
AU - Neelapu, Sattva S.
AU - Pastores, Stephen M.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Purpose: A task force of experts from 11 United States (US) centers, sought to describe practices for managing chimeric antigen receptor (CAR) T-cell toxicity in the intensive care unit (ICU). Materials and methods: Between June–July 2019, a survey was electronically distributed to 11 centers. The survey addressed: CAR products, toxicities, targeted treatments, management practices and interventions in the ICU. Results: Most centers (82%) had experience with commercial and non-FDA approved CAR products. Criteria for ICU admission varied between centers for patients with Cytokine Release Syndrome (CRS) but were similar for Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS). Practices for vasopressor support, neurotoxicity and electroencephalogram monitoring, use of prophylactic anti-epileptic drugs and tocilizumab were comparable. In contrast, fluid resuscitation, respiratory support, methods of surveillance and management of cerebral edema, use of corticosteroid and other anti-cytokine therapies varied between centers. Conclusions: This survey identified areas of investigation that could improve outcomes in CAR T-cell recipients such as fluid and vasopressor selection in CRS, management of respiratory failure, and less common complications such as hemophagocytic lymphohistiocytosis, infections and stroke. The variability in specific treatments for CAR T-cell toxicities, needs to be considered when designing future outcome studies of critically ill CAR T-cell patients.
AB - Purpose: A task force of experts from 11 United States (US) centers, sought to describe practices for managing chimeric antigen receptor (CAR) T-cell toxicity in the intensive care unit (ICU). Materials and methods: Between June–July 2019, a survey was electronically distributed to 11 centers. The survey addressed: CAR products, toxicities, targeted treatments, management practices and interventions in the ICU. Results: Most centers (82%) had experience with commercial and non-FDA approved CAR products. Criteria for ICU admission varied between centers for patients with Cytokine Release Syndrome (CRS) but were similar for Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS). Practices for vasopressor support, neurotoxicity and electroencephalogram monitoring, use of prophylactic anti-epileptic drugs and tocilizumab were comparable. In contrast, fluid resuscitation, respiratory support, methods of surveillance and management of cerebral edema, use of corticosteroid and other anti-cytokine therapies varied between centers. Conclusions: This survey identified areas of investigation that could improve outcomes in CAR T-cell recipients such as fluid and vasopressor selection in CRS, management of respiratory failure, and less common complications such as hemophagocytic lymphohistiocytosis, infections and stroke. The variability in specific treatments for CAR T-cell toxicities, needs to be considered when designing future outcome studies of critically ill CAR T-cell patients.
KW - CAR-ICU
KW - Chimeric antigen receptor T-cell
KW - Cytokine release syndrome
KW - Immune effector cell associated neurotoxicity syndrome
KW - Intensive care unit
KW - Toxicities
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U2 - 10.1016/j.jcrc.2020.04.008
DO - 10.1016/j.jcrc.2020.04.008
M3 - Article
C2 - 32361219
AN - SCOPUS:85083790914
SN - 0883-9441
VL - 58
SP - 58
EP - 64
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -