CAR-T in Scotland

25/11/2020 - Chris Wright

Cardiac Monitoring, plus keppra, plus screening for toxicity, plus infection prophylaxis

Then this thing causes a massive IL6 IL2 IL1 response CAR-T's kill tumour cells but can also do a fair bit of damage to patient

Cytokine Release Syndrome (Post CAR T, but also can be caused in bone marrow transplants)

SIRS type syndeme, fever, capillary leak, MODS

HIGH fever and multi system involvement

Dependent on underlying disease, disease burden, and co-stimulatory domain of CAR-T product.

As it looks like sepsis you generally have to treat for both

Diagnose it by picking up on screening.

Your overall grade is based on your worst score.

Treat with:

Tociluzimab - IL6 Blockade Siltuximab - Direct IL6 Blockade

We don't know what causes it, it seems seperate to CRS

It's not related to IL6 in the same way

It seems to be like a toxic encephalopathy

Cerebral oedema at the worst end

Generally it seems to be reversible with no permanent outcome.

MRI positive findings seem to indicate poorer outcomes

Patients recieve daily EEG to exclude Seizure Activity

There is a scoring score for Neurotoxicity called the ICE score.

Goes from Grade 1 to Grade 4 (4 is worst)

Grade 2 upwards gets admitted to ICU.

To avoid ICANS patients get baseline CT and prophylactic keppra