Pediatric CAR T-cell therapy guidelines highlight need for interdisciplinary monitoring

Children treated with chimeric antigen receptor T-cell therapy experience unique toxicities that require careful monitoring to prevent serious sequalae, according to new management guidelines.

An educated interdisciplinary team — including nurses, trainees, intensivists and cell therapists — is essential to identify early signs and symptoms of cytokine release syndrome (CRS) and chimeric antigen receptor (CAR)-T-cell-related encephalopathy syndrome (CRES), the two most common toxicities associated with CAR T-cell therapy.
In November 2017, the FDA approved tisagenlecleucel (Kymriah, Novartis) for the treatment of children with acute lymphoblastic leukemia.

“As this approval moved to standard of care in pediatrics, we though that it was important to have guidelines that would provide a universal framework for this and other products that may be approved,” Kris M. Mahadeo, MD, MPH, section chief and medical director of pediatric stem cell transplantation and cellular therapy at The University of Texas MD Anderson Cancer Center, told HemOnc Today. “We recognized that there wasn’t going to be a one-size-fits-all approach, but that we needed some sort of overarching infrastructure in place in order to have this therapy safely delivered across institutions, outside of the context of a clinical trial.”
Last year, researchers from MD Anderson Cancer Center published guidelines about the management of patients undergoing CAR T-cell therapy, focused primarily on adults.

Experts from the hematopoietic stem cell transplant subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the CAR T-cell Therapy-Associated Toxicity Program (CARTOX) at MD Anderson Cancer Center worked to create pediatric-focused guidelines, as recognition of toxicities among children may present subtly.

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