Management of CAR T-cell related toxicities: What did the learning curve teach us so far?

Chimeric antigen receptor T cell (CAR-T) therapy is an immunotherapy, which represents a therapeutic breakthrough in the treatment of B-cell malignancies and multiple myeloma. Since the first CAR T-cell approval in 2017, there have been five FDA approved CAR-T products, more approved disease indications for CAR-T therapy, and investigational trials launched for other cancers, including solid organ malignancies. CAR-T therapy possesses unique toxicities. Better understanding of these toxicities over time has helped in more efficient diagnosis, management, and treatment strategies. This review will focus on CAR-T-related toxicities including cytokine release syndrome, immune effector cell associated neurotoxicity syndrome (ICANS), cytokine release syndrome (CRS), and hemophagocytic lymphohistiocytosis (HLH)/ macrophage activation syndrome in terms of assessment, grading, and current management strategies. Additionally, this review will cover future directions and research on CAR-T-related toxicities.