Cancer Biology & Medicine (Feb 2023)
2022 Chinese expert consensus and guidelines on clinical management of toxicity in anti-CD19 chimeric antigen receptor T-cell therapy for B-cell non-Hodgkin lymphoma
- Ping Li,
- Yang Liu,
- Yun Liang,
- Jian Bo,
- Sujun Gao,
- Yongxian Hu,
- Yu Hu,
- He Huang,
- Xiaojun Huang,
- Hongmei Jing,
- Xiaoyan Ke,
- Jianyong Li,
- Yuhua Li,
- Qifa Liu,
- Peihua Lu,
- Heng Mei,
- Ting Niu,
- Yongping Song,
- Yuqin Song,
- Liping Su,
- Sanfang Tu,
- Jianxiang Wang,
- Depei Wu,
- Zhao Wang,
- Kailin Xu,
- Zhitao Ying,
- Qingming Yang,
- Yajing Zhang,
- Fengxia Shi,
- Bin Zhang,
- Huilai Zhang,
- Xi Zhang,
- Mingfeng Zhao,
- Weili Zhao,
- Xiangyu Zhao,
- Liang Huang,
- Jun Zhu,
- Wenbin Qian,
- Weidong Han,
- Aibin Liang
Affiliations
- Ping Li
- Department of Hematology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
- Yang Liu
- Department of Bio-therapeutic, Chinese PLA General Hospital, Beijing 100853, China
- Yun Liang
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
- Jian Bo
- Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China
- Sujun Gao
- Department of Hematology, The First Hospital of Jilin University, Changchun 130012, China
- Yongxian Hu
- Center for Bone Marrow Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Yu Hu
- Institute of Hematology, Union Hospital of Tongji Medical College; Huazhong University of Science and Technology, Wuhan 430022, China
- He Huang
- Center for Bone Marrow Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Xiaojun Huang
- Peking University People’s Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
- Hongmei Jing
- Department of Hematology, Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, China
- Xiaoyan Ke
- Department of Hematology, Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, China
- Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
- Yuhua Li
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- Peihua Lu
- Lu Daopei Institute of Hematology, Beijing 101102, China
- Heng Mei
- Institute of Hematology, Union Hospital of Tongji Medical College; Huazhong University of Science and Technology, Wuhan 430022, China
- Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
- Yongping Song
- The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
- Yuqin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
- Liping Su
- Department of Hematology, Shanxi Cancer Hospital, Taiyuan 030013, China
- Sanfang Tu
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
- Jianxiang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Division of Pediatric Blood Disease Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
- Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou 215006, China
- Zhao Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, China
- Zhitao Ying
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
- Qingming Yang
- Department of Bio-therapeutic, Chinese PLA General Hospital, Beijing 100853, China
- Yajing Zhang
- Department of Bio-therapeutic, Chinese PLA General Hospital, Beijing 100853, China
- Fengxia Shi
- Department of Bio-therapeutic, Chinese PLA General Hospital, Beijing 100853, China
- Bin Zhang
- Institute of Blood and Marrow Transplantation, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100039, China
- Huilai Zhang
- Department of Lymphoma, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
- Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing 400037, China
- Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300192, China
- Weili Zhao
- Department of Hematology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Xiangyu Zhao
- Peking University People’s Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
- Liang Huang
- Department of Hematology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Jun Zhu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing 100142, China
- Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
- Weidong Han
- Department of Bio-therapeutic, Chinese PLA General Hospital, Beijing 100853, China
- Aibin Liang
- Department of Hematology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
- DOI
- https://doi.org/10.20892/j.issn.2095-3941.2022.0585
- Journal volume & issue
-
Vol. 20,
no. 2
pp. 129 – 146
Abstract
Adoptive cellular immunotherapy with chimeric antigen receptor (CAR) T cells has emerged as a novel modality for treating relapsed and/or refractory B-cell non-Hodgkin lymphoma (B-NHL). With increasing approval of CAR T-cell products and advances in CAR T cell therapy, CAR T cells are expected to be used in a growing number of cases. However, CAR T-cell-associated toxicities can be severe or even fatal, thus compromising the survival benefit from this therapy. Standardizing and studying the clinical management of these toxicities are imperative. In contrast to other hematological malignancies, such as acute lymphoblastic leukemia and multiple myeloma, anti-CD19 CAR T-cell-associated toxicities in B-NHL have several distinctive features, most notably local cytokine-release syndrome (CRS). However, previously published guidelines have provided few specific recommendations for the grading and management of toxicities associated with CAR T-cell treatment for B-NHL. Consequently, we developed this consensus for the prevention, recognition, and management of these toxicities, on the basis of published literature regarding the management of anti-CD19 CAR T-cell-associated toxicities and the clinical experience of multiple Chinese institutions. This consensus refines a grading system and classification of CRS in B-NHL and corresponding measures for CRS management, and delineates comprehensive principles and exploratory recommendations for managing anti-CD19 CAR T-cell-associated toxicities in addition to CRS.
Keywords
- car t-cell therapy
- b-cell non-hodgkin lymphoma
- toxicity
- cytokine-release syndrome
- clinical management
