Immunonkologie trifft Intensivmedizin: CAR-T-Zellen

Zusammenfassung

Die Behandlung mit CAR-T-Zellen kann zwar keine „Wunder“ vollbringen, aber sie führt bei einem Teil der Patienten zu spektakulärem Ansprechen und mitunter sogar zur Heilung von bisher palliativen Patienten. Dennoch: Regelhaft geht die Anwendung dieser zielgerichteten Therapie mit schweren Nebenwirkungen einher, die zumeist intensivmedizinischen Einsatz erfordern. Wie es dazu kommt und wie dem zu begegnen ist, zeigt dieser Beitrag.

Abstract

CAR-T cells, genetically modified tumor-targeted t-cells, revolutionized the treatment of refractory B-cell malignancies. CAR-T cell treatment however, is invariably associated with severe immune-mediated toxicities, namely Cytokine Release Syndrome (CRS) and neurological toxicity (CRES/ICANS). Although knowledge on the pathomechanism of these toxicities is still very limited, recent findings including mouse models might allow prediction, earlier recognition and targeted treatment of patients suffering from these potentially life-threatening side effects. This article summarizes current knowledge and recent findings on the management of severe CAR-T associated toxicities and gaps of knowledge stressing the importance of an interdisciplinary approach including hematology-oncology and Intensive Care Medicine.

Schlüsselwörter

CAR-T-Zellen - Cytokine Release Syndrome - ICANS - Tocilizumab - Anakinra

Key words

CAR-T cells - Cytokine Release Syndrome - ICANS - Tocilizumab - Anakinra

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