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Management of complications of CAR T-cell therapies in Europe
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A survey conducted by the European Society for Blood and Marrow Transplantation (EBMT) assessed the management of short- and long-term complications in patients with acute lymphoblastic leukemia, lymphoma, and multiple myeloma who were treated with chimeric antigen receptor (CAR) T-cell therapies. The survey included 106 EBMT CAR T-cell centers and was carried out between February 23, 2023, and April 27, 2023. Results from this survey were published in Haematologica by Penack et al.1 |
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The management of steroid-refractory and very severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were identified as critical areas needing harmonization in treatment approaches. Anakinra was widely used in severe cases, but optimal dosing remains undetermined, indicating a need for further research. |
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Prolonged cytopenias post CAR T-cell therapy were common, yet there is no consensus on the best management strategy. While more than half of centers considered stem cell boosts, the timing and criteria for this intervention vary widely, underscoring the need for more robust evidence-based protocols. |
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Immunoglobulin G deficiency management post CAR T-cell therapy was inconsistent, with practices ranging from routine substitution in asymptomatic patients to only treating severe cases. This variation suggests a need for more definitive guidelines to optimize patient outcomes. |
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The management of CAR T-cell therapy complications showed significant variability across European centers, highlighting a need for standardized treatment guidelines. This inconsistency in practice reflects a reliance on expert knowledge due to the lack of extensive clinical trial data. These results suggest a need for the collection of more clinical evidence, by integrating concepts for complication management in clinical trials, and increasing collaborative efforts of harmonization. |
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