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

DOI
https://doi.org/10.20892/j.issn.2095-3941.2022.0585
Journal volume & issue
Vol. 20, no. 2
pp. 129 – 146

Abstract

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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.

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