ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells
- PMID: 30592986
- DOI: 10.1016/j.bbmt.2018.12.758
ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells
Abstract
Chimeric antigen receptor (CAR) T cell therapy is rapidly emerging as one of the most promising therapies for hematologic malignancies. Two CAR T products were recently approved in the United States and Europe for the treatment ofpatients up to age 25years with relapsed or refractory B cell acute lymphoblastic leukemia and/or adults with large B cell lymphoma. Many more CAR T products, as well as other immunotherapies, including various immune cell- and bi-specific antibody-based approaches that function by activation of immune effector cells, are in clinical development for both hematologic and solid tumor malignancies. These therapies are associated with unique toxicities of cytokine release syndrome (CRS) and neurologic toxicity. The assessment and grading of these toxicities vary considerably across clinical trials and across institutions, making it difficult to compare the safety of different products and hindering the ability to develop optimal strategies for management of these toxicities. Moreover, some aspects of these grading systems can be challenging to implement across centers. Therefore, in an effort to harmonize the definitions and grading systems for CRS and neurotoxicity, experts from all aspects of the field met on June 20 and 21, 2018, at a meeting supported by the American Society for Transplantation and Cellular Therapy (ASTCT; formerly American Society for Blood and Marrow Transplantation, ASBMT) in Arlington, VA. Here we report the consensus recommendations of that group and propose new definitions and grading for CRS and neurotoxicity that are objective, easy to apply, and ultimately more accurately categorize the severity of these toxicities. The goal is to provide a uniform consensus grading system for CRS and neurotoxicity associated with immune effector cell therapies, for use across clinical trials and in the postapproval clinical setting.
Keywords: CAR T cell therapy; Cellular immunotherapy; Consensus grading; Cytokine release syndrome; Immune effector cell; Neurotoxicity.
Copyright © 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Comment in
-
Comments Regarding "ASBMT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells".Biol Blood Marrow Transplant. 2019 Jun;25(6):e209-e210. doi: 10.1016/j.bbmt.2019.02.027. Epub 2019 Mar 9. Biol Blood Marrow Transplant. 2019. PMID: 30862467 No abstract available.
-
Reply.Biol Blood Marrow Transplant. 2019 Jun;25(6):e211-e212. doi: 10.1016/j.bbmt.2019.03.019. Epub 2019 Mar 23. Biol Blood Marrow Transplant. 2019. PMID: 30910604 No abstract available.
Similar articles
-
[Interpretation of ASTCT Consensus Responses by Chimeric Antigen Receptor T Cell Therapy CRS/ICANS--Review].Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Dec;29(6):1982-1986. doi: 10.19746/j.cnki.issn.1009-2137.2021.06.051. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021. PMID: 34893146 Chinese.
-
Comparing CAR T-cell toxicity grading systems: application of the ASTCT grading system and implications for management.Blood Adv. 2020 Feb 25;4(4):676-686. doi: 10.1182/bloodadvances.2019000952. Blood Adv. 2020. PMID: 32084260 Free PMC article.
-
Management of cytokine release syndrome and neurotoxicity in chimeric antigen receptor (CAR) T cell therapy.Expert Rev Hematol. 2019 Mar;12(3):195-205. doi: 10.1080/17474086.2019.1585238. Epub 2019 Mar 18. Expert Rev Hematol. 2019. PMID: 30793644 Review.
-
Cytokine Release Syndrome with Chimeric Antigen Receptor T Cell Therapy.Biol Blood Marrow Transplant. 2019 Apr;25(4):e123-e127. doi: 10.1016/j.bbmt.2018.12.756. Epub 2018 Dec 23. Biol Blood Marrow Transplant. 2019. PMID: 30586620 Review.
-
Plasma Exchange Can Be an Alternative Therapeutic Modality for Severe Cytokine Release Syndrome after Chimeric Antigen Receptor-T Cell Infusion: A Case Report.Clin Cancer Res. 2019 Jan 1;25(1):29-34. doi: 10.1158/1078-0432.CCR-18-1379. Epub 2018 Oct 15. Clin Cancer Res. 2019. PMID: 30322878
Cited by
-
Claudin18.2-specific CAR T cells in gastrointestinal cancers: phase 1 trial final results.Nat Med. 2024 Jun 3. doi: 10.1038/s41591-024-03037-z. Online ahead of print. Nat Med. 2024. PMID: 38830992
-
Impact of Extraosseous Extramedullary Disease on Outcomes of Patients with Relapsed-Refractory Multiple Myeloma receiving Standard-of-Care Chimeric Antigen Receptor T-Cell Therapy.Blood Cancer J. 2024 May 31;14(1):90. doi: 10.1038/s41408-024-01068-w. Blood Cancer J. 2024. PMID: 38821914 Free PMC article.
-
The Implementation of Chimeric Antigen Receptor (CAR) T-cell Therapy in Pediatric Patients: Where Did We Come From, Where Are We Now, and Where are We Going?Clin Hematol Int. 2024 Mar 13;6(1):96-115. doi: 10.46989/001c.94386. eCollection 2024. Clin Hematol Int. 2024. PMID: 38817691 Free PMC article. Review.
-
Prognostic impact of corticosteroid and tocilizumab use following chimeric antigen receptor T-cell therapy for multiple myeloma.Blood Cancer J. 2024 May 27;14(1):84. doi: 10.1038/s41408-024-01048-0. Blood Cancer J. 2024. PMID: 38802346 Free PMC article.
-
Immunotherapy-related cognitive impairment after CAR T cell therapy in mice.bioRxiv [Preprint]. 2024 May 14:2024.05.14.594163. doi: 10.1101/2024.05.14.594163. bioRxiv. 2024. PMID: 38798554 Free PMC article. Preprint.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Miscellaneous