CAR T Cell Toxicities and Emerging Treatment Strategies

Having already revolutionized outcomes for relapsed or refractory B cell malignancies and multiple myeloma, chimeric antigen receptor (CAR) T cell therapy is on the cusp of significantly impacting those with solid tumors. However, antitumor response is frequently associated with acute toxicities due to immune hyperactivation, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, immune effector cell-associated hematotoxicity, and immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome. We discuss the clinical presentations, evaluation, management, risk factors, and pathophysiologies of these toxicities and briefly describe emerging toxicity mitigation strategies.