denotes an abstract that is clinically relevant.
denotes that this is a recommended PHD Trainee Session.
denotes that this is a ticketed session.Hematology Disease Topics & Pathways:
Research, Clinical Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Treatment Considerations, Biological therapies, Adverse Events
Description:
CAR T-cell therapy has become a standard treatment option resulting in improved progression-free and overall survival in a variety of relapsed and refractory adult hematologic malignancies. The acute toxicities, particularly CRS and ICANS, and outcomes of CAR T-cell therapy have been extensively described. However, as indications and utilization of this treatment have expanded with increasing reports of long-term survivors, it has become increasingly apparent that there are a number of clinically significant, long-term complications and toxicities that may occur in CAR T-cell recipients. Recognition and understanding of these long-term complications are imperative to patient selection, counseling, and management. This session will review and provide guidelines for monitoring and treatment of long-term complications after CAR T-cell therapy in adult patients.
Measuring disease-related and treatment-driven patient-reported outcomes (PROs) as standard of care in patients undergoing CAR T-cell therapy is both feasible and vital. As has been shown with numerous oncology therapies, the assessment of symptom and functioning PROs is now sufficiently mature to justify their contribution to treatment precision, efficiency, and standardization and national and international collaborations. Nonetheless, collaborative efforts among clinicians, symptom researchers, and electronic health system designers are needed to integrate evidence-based PROs into routine patient care after CAR-T cell therapy. This will help in capturing early toxicity and implement timely interventions with the ultimate goal of improving treatment tolerability related to symptom burden and CAR T-cell clinical outcomes.
Adults receiving chimeric antigen receptor (CAR) T-cell therapy may experience late complications distinct from those in the early CAR T-cell treatment period. Late complications include cytopenias, infections, secondary malignancies, and delayed neurotoxicities. Late cytopenias may be from prolonged recovery after lymphodepleting chemotherapy or arise anew, raising concerns for recurrent disease or a secondary malignancy. Late infections, which are predominantly viral, may require ongoing prophylaxis and immunoglobulin replacement therapy. Both hematologic and solid secondary malignancies are a known risk of CAR T-cell therapy, with recent observations of T-cell cancers. It is essential to monitor for late complications in adult patients receiving CAR T-cells to improve the outcomes and quality of life.
Infections following CAR-T remain a notable cause of morbidity and mortality not only in the early (<30 days) post-CAR-T but also persist through the prolonged (30-90 days) and late (>90 days) follow-up. The predisposition to infections results from immunosuppression related to underlying disease, prior cytotoxic therapies, lymphodepletion chemotherapy, delayed hematopoietic recovery, B-cell aplasia, and delayed T-cell immune reconstitution. This draft delineates risk factors and epidemiology of infections along the post-CAR-T timeline. Dr. Jain will further discuss our approach to mitigation and management of infections including antibacterial, antiviral, and antifungal prophylaxis, growth factors to expedite count recovery, immunoglobulin replacement therapy, and re-vaccination programs.
Measuring disease-related and treatment-driven patient-reported outcomes (PROs) as standard of care in patients undergoing CAR T-cell therapy is both feasible and vital. As has been shown with numerous oncology therapies, the assessment of symptom and functioning PROs is now sufficiently mature to justify their contribution to treatment precision, efficiency, and standardization and national and international collaborations. Nonetheless, collaborative efforts among clinicians, symptom researchers, and electronic health system designers are needed to integrate evidence-based PROs into routine patient care after CAR-T cell therapy. This will help in capturing early toxicity and implement timely interventions with the ultimate goal of improving treatment tolerability related to symptom burden and CAR T-cell clinical outcomes.
Adults receiving chimeric antigen receptor (CAR) T-cell therapy may experience late complications distinct from those in the early CAR T-cell treatment period. Late complications include cytopenias, infections, secondary malignancies, and delayed neurotoxicities. Late cytopenias may be from prolonged recovery after lymphodepleting chemotherapy or arise anew, raising concerns for recurrent disease or a secondary malignancy. Late infections, which are predominantly viral, may require ongoing prophylaxis and immunoglobulin replacement therapy. Both hematologic and solid secondary malignancies are a known risk of CAR T-cell therapy, with recent observations of T-cell cancers. It is essential to monitor for late complications in adult patients receiving CAR T-cells to improve the outcomes and quality of life.
Infections following CAR-T remain a notable cause of morbidity and mortality not only in the early (<30 days) post-CAR-T but also persist through the prolonged (30-90 days) and late (>90 days) follow-up. The predisposition to infections results from immunosuppression related to underlying disease, prior cytotoxic therapies, lymphodepletion chemotherapy, delayed hematopoietic recovery, B-cell aplasia, and delayed T-cell immune reconstitution. This draft delineates risk factors and epidemiology of infections along the post-CAR-T timeline. Dr. Jain will further discuss our approach to mitigation and management of infections including antibacterial, antiviral, and antifungal prophylaxis, growth factors to expedite count recovery, immunoglobulin replacement therapy, and re-vaccination programs.