emDOCs.net Emergency Medicine (EM) Podcast Episode 77: CAR T-cell and Cytokine Release Syndrome
May 9, 2023
A concise walkthrough of CAR T-cell therapy basics and how the treatment is made and used. A focused look at cytokine release syndrome: what it is, when it appears, and its clinical range. Practical emergency evaluation and tests to consider when CRS is suspected. Management priorities in the ED and definitive treatments like IL-6 blockade and steroids.
AI Snips
Chapters
Transcript
Episode notes
How CAR T Cell Therapy Works
- CAR T-cell therapy engineers a patient's T-cells with antigen receptors to target cancer cells after lymphodepletion chemotherapy.
- T-cells are harvested, genetically modified to express CAR receptors, expanded in vitro, then infused back to attack leukemias and some lymphomas and myeloma.
Outpatient Infusions Carry Serious Risks
- CAR T infusions are usually outpatient but can cause several serious complications including CRS and ICANS.
- Other risks include cardiac toxicity, tumor lysis, cytopenias, infusion reactions, and graft-versus-host disease.
CRS Is A Hyperinflammatory Endothelial Cascade
- Cytokine release syndrome (CRS) is a hyperinflammatory response with elevated cytokines and endothelial/macrophage activation causing fever and organ dysfunction.
- CRS incidence is highest in ALL (25–50%) and varies with tumor burden, lymphodepletion, CAR T dose, and T-cell activation.