Cytokine release syndrome after CAR T-cell therapy for B-cell acute lymphoblastic leukemia in children and young adolescents: storms make trees take deeper roots.

IF 2.5 3区 医学 Q3 PHARMACOLOGY & PHARMACY Expert Opinion on Pharmacotherapy Pub Date : 2024-08-01 Epub Date: 2024-08-06 DOI:10.1080/14656566.2024.2387673
Magalie Tardif, Nida Usmani, Maja Krajinovic, Henrique Bittencourt
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Abstract

Introduction: Chimeric antigen receptor (CAR) T-cells have revolutionized cancer treatment, showing significant success, including treatment of pediatric B-cell acute lymphoblastic leukemia (B-ALL). Despite their efficacy, cytokine release syndrome (CRS) emerges as a common early adverse effect that can be life threatening in severe cases, resulting from the immune system's targeted activation against tumors.

Areas covered: This review concentrates on CRS in children and young adults undergoing CAR T-cell therapy for B-ALL. It explores CRS pathophysiology, clinical presentation, and incidence, emphasizing the importance of a consensus definition and grading to homogenize the treatment according to the severity of symptoms. We will discuss the standard of care treatment of CRS but also novel approaches. We will highlight the importance of managing CRS without compromising the efficacy of immune cell activation against tumors.

Expert opinion: As CAR T-cell therapy in pediatric B-ALL become increasingly available and used, optimal management of CRS becomes increasingly important. Early recognition and timely management has improved. Further information will aid us to identify optimal timing of tocilizumab and corticosteroids. Continued bench research coupled with clinical studies and biomarker discovery will allow for valuable insights into CRS pathophysiology and patient and/or cell-targeted treatments.

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儿童和青少年 B 细胞急性淋巴细胞白血病 CAR T 细胞疗法后的细胞因子释放综合征:风暴让树木扎根更深。
简介嵌合抗原受体(CAR)T细胞彻底改变了癌症治疗,取得了显著的成功,包括治疗小儿B细胞急性淋巴细胞(B-ALL)白血病。尽管疗效显著,但细胞因子释放综合征(CRS)是一种常见的早期不良反应,严重时可危及生命:本综述主要关注接受 CAR T 细胞疗法治疗 B-ALL 的儿童和年轻成人的 CRS。它探讨了 CRS 的病理生理学、临床表现和发病率,强调了共识定义和分级的重要性,以便根据症状的严重程度进行同质化治疗。我们将讨论 CRS 的标准治疗方法以及新方法。我们将强调在不影响免疫细胞激活抗肿瘤疗效的前提下管理CRS的重要性:随着CAR T细胞疗法在小儿B-ALL中的普及和应用,细胞因子释放综合征的优化管理变得越来越重要。早期识别和及时处理已得到改善。进一步的信息将有助于我们确定使用托西珠单抗和皮质类固醇的最佳时机。持续的临床研究和生物标志物的发现将有助于我们深入了解 CRS 的病理生理学以及针对患者和/或细胞的治疗方法。
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来源期刊
CiteScore
5.60
自引率
3.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Expert Opinion on Pharmacotherapy is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles and original papers on newly approved/near to launch compounds mainly of chemical/synthetic origin, providing expert opinion on the likely impact of these new agents on existing pharmacotherapy of specific diseases.
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