Ira Braunschweig, MD, director, Stem Cell Transplant Program, clinical program director, Hematologic Malignancies, Montefiore Medical Center, associate professor, Department of Medicine (Oncology), Albert Einstein College of Medicine, discusses mitigating ​the toxicities that are associated with CAR T-cell therapy in lymphoma.

Despite the encouraging responses that have been observed with CAR T-cell therapy in lymphoma, several toxicities ​can arise with these products.

However, data suggests that ​administration of the immunosuppressive agent 

 (Actemra) at fever onset could help mitigate some of the adverse effects, such as cytokine release syndrome, says Braunschweig. Notably, this agent will not abrogate the anti-tumor effect of the cellular therapy. 

Furthermore, ​data have shown that ​early steroid use may mitigate neurotoxicity, Braunschweig adds. ​Using steroids, which kill lymphocytes, may seem counterintuitive as CAR T cells are lymphocytes. However,​ steroids appear to mitigate neurotoxicity without alter​ing the mechanism of​ action of the​ CAR T-cell therapy.

Utilizing steroids early may eliminate the risk of confusion or, in severe cases, coma, among patients with lymphoma who receive CAR T-cell therapy, Braunschweig concludes.

Videos

Ira Braunschweig, MD, discusses mitigating ​the toxicities that are associated with CAR T-cell therapy in lymphoma.

Dr. Braunschweig on Mitigating the Toxicities of CAR T-Cell Therapy in Lymphoma 

Ira Braunschweig, MD, director, Stem Cell Transplant Program, clinical program director, Hematologic Malignancies, Montefiore Medical Center, associate professor, Department of Medicine (Oncology), Albert Einstein College of Medicine, discusses factors to consider when selecting between autologous stem cell transplant (ASCT), allogeneic stem cell transplant (allo-SCT), and CAR T-cell therapy in diffuse large B-cell lymphoma (DLBCL).

In patients with chemotherapy-sensitive DLBCL, ASCT remains the standard of care, says Braunschweig. This is likely due to the fact that the field has decades worth of experience in treating this patient population with ASCT.

However, CAR T-cell therapy appears to be the clear treatment choice for patients with primary refractory DLBCL, Braunschweig explains.


Historically, patients who progressed after ASCT received an allo-SCT, which can have curative potential, says Braunschweig. However, many patients experience graft-versus-host disease and ongoing health issues following allo-SCT.

Alternatively, if patients can tolerate the toxicities that tend to arise within the first few weeks after CAR T-cell therapy, they have a decreased risk for long-term health issues compared with allo-SCT, Braunschweig says.

Moreover, unlike with transplant, CAR T-cell therapy eliminates the need to aggregate antitumor response, which may make it a more appealing option for patients, concludes Braunschweig.

Ira Braunschweig, MD, discusses factors to consider when selecting between autologous stem cell transplant, allogeneic stem cell transplant, and CAR T-cell therapy in diffuse large B-cell lymphoma.  



Ira Braunschweig, MD

Articles

Dr. Braunschweig on Mitigating the Toxicities of CAR T-Cell Therapy in Lymphoma

Dr. Braunschweig on Selecting Between Transplant and CAR T-Cell Therapy in DLBCL