The chimeric antigen receptor-intensive care unit (CAR-ICU) initiative: Surveying intensive care unit practices in the management of CAR T-cell associated toxicities

Cristina Gutierrez; Anne Rain T Brown; Megan M Herr; Sameer S Kadri; Brian Hill; Prabalini Rajendram; Abhijit Duggal; Cameron J Turtle; Kevin Patel; Yi Lin; Heather P May; Alice Gallo de Moraes; Marcela V Maus; Mathew J Frigault; Jennifer N Brudno; Janhavi Athale; Nirali N Shah; James N Kochenderfer; Ananda Dharshan; Amer Beitinjaneh; Alejandro S Arias; Colleen McEvoy; Elena Mead; R. Scott Stephens; Joseph L Nates; Sattva S Neelapu; Stephen M Pastores

doi:10.1016/j.jcrc.2020.04.008

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The chimeric antigen receptor-intensive care unit (CAR-ICU) initiative: Surveying intensive care unit practices in the management of CAR T-cell associated toxicities

Journal article

Peer reviewed

The chimeric antigen receptor-intensive care unit (CAR-ICU) initiative: Surveying intensive care unit practices in the management of CAR T-cell associated toxicities

Cristina Gutierrez, Anne Rain T Brown, Megan M Herr, Sameer S Kadri, Brian Hill, Prabalini Rajendram, Abhijit Duggal, Cameron J Turtle, Kevin Patel, Yi Lin, …

Journal of critical care, Vol.58, pp.58-64

2020-08

DOI: https://doi.org/10.1016/j.jcrc.2020.04.008

PMID: 32361219

Abstract

Cytokine release syndrome

Immune effector cell associated neurotoxicity syndrome

Toxicities

Chimeric antigen receptor T-cell

Intensive care unit

CAR-ICU

A task force of experts from 11 United States (US) centers, sought to describe practices for managing chimeric antigen receptor (CAR) T-cell toxicity in the intensive care unit (ICU). Between June–July 2019, a survey was electronically distributed to 11 centers. The survey addressed: CAR products, toxicities, targeted treatments, management practices and interventions in the ICU. Most centers (82%) had experience with commercial and non-FDA approved CAR products. Criteria for ICU admission varied between centers for patients with Cytokine Release Syndrome (CRS) but were similar for Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS). Practices for vasopressor support, neurotoxicity and electroencephalogram monitoring, use of prophylactic anti-epileptic drugs and tocilizumab were comparable. In contrast, fluid resuscitation, respiratory support, methods of surveillance and management of cerebral edema, use of corticosteroid and other anti-cytokine therapies varied between centers. This survey identified areas of investigation that could improve outcomes in CAR T-cell recipients such as fluid and vasopressor selection in CRS, management of respiratory failure, and less common complications such as hemophagocytic lymphohistiocytosis, infections and stroke. The variability in specific treatments for CAR T-cell toxicities, needs to be considered when designing future outcome studies of critically ill CAR T-cell patients. •Despite the high acuity of illness of CRS and ICANS, there is limited data in its ICU management•The CAR-ICU (11 leading institutions within the US) focuses on studying critically ill CAR T-cell patients•Our survey reports the structure and practices of care for CAR patients in different ICUs•Practices in the management of CAR T-cell patients varies within institutions in the US•We identify areas of future research that could impact outcomes of critically ill CAR T-cell patients.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.6 Immunology; 1.6.214 PD-1
Web Of Science research areas: Critical Care Medicine
ESI research areas: Clinical Medicine

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Title: The chimeric antigen receptor-intensive care unit (CAR-ICU) initiative: Surveying intensive care unit practices in the management of CAR T-cell associated toxicities
Creators: Cristina Gutierrez - Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States of America
Anne Rain T Brown - Clinical Pharmacy Specialist in Critical Care, Department of Pharmacy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States of America
Megan M Herr - Transplant and Cellular Therapy Program, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States of America
Sameer S Kadri - Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States of America
Brian Hill - Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
Prabalini Rajendram - Department of Critical Care, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine, Cleveland, OH, United States of America
Abhijit Duggal - Medical Intensive Care Unit, Cleveland Clinic and Assistant Professor of Medicine, Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, United States of America
Cameron J Turtle - Anderson Family Endowed Chair for Immunotherapy, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, United States of America
Kevin Patel - Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle Cancer Alliance, Seattle, WA, United States of America
Yi Lin - Division of Hematology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, United States of America
Heather P May - Mayo Clinic College of Medicine and Science, Critical Care Clinical Pharmacist, Department of Pharmacy, Mayo Clinic, Rochester, MN, United States of America
Alice Gallo de Moraes - Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, United States of America
Marcela V Maus - Cellular Immunotherapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
Mathew J Frigault - Cellular Immunotherapy Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
Jennifer N Brudno - Assistant Research Physician, Surgery Branch, National Cancer Institute, National Institutes of Health, United States of America
Janhavi Athale - Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States of America
Nirali N Shah - Pediatric Oncology Branch, National Cancer Institute, National Institute of Health, United States of America
James N Kochenderfer - Surgery Branch of the National Cancer Institute, National Cancer Institute, National Institute of Health, United States of America
Ananda Dharshan - Intensive Care Unit, Roswell Park Comprehensive Cancer Center, Department of Anesthesiology, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States of America
Amer Beitinjaneh - Department of Medicine, Division of Transplantation and Cellular Therapy, University of Miami, Miami, FL, United States of America
Alejandro S Arias - Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL, United States of America
Colleen McEvoy - Stem Cell Transplant and Oncology Intensive Care Unit, Assistant Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
Elena Mead - Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, United States of America
R. Scott Stephens - Oncology and Bone Marrow Transplant Critical Care, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States of America
Joseph L Nates - Surgical and Medical Intensive Care Units, Division of Anesthesiology and Critical Care, Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States of America
Sattva S Neelapu - Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
Stephen M Pastores - Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, United States of America
Publication Details: Journal of critical care, Vol.58, pp.58-64
Publisher: Elsevier Inc
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Hematology/Oncology
Language: English
Resource Type: Journal article
PMID: 32361219
Record Identifier: 991031599172602976