Dr. Patel on Mitigating CAR T-Cell Therapy­–Related CRS in Multiple Myeloma

Krina K. Patel, MD, MSc, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses mitigating CAR T-cell therapy–related cytokine release syndrome (CRS) in multiple myeloma.

Toxicity can be a limiting factor with CAR T-cell therapy in hematologic malignancies, Patel says. In lymphoma, key toxicities associated with CAR T-cell therapy include CRS and neurotoxicity; however, in multiple myeloma, CRS is the main toxicity to be aware of, Patel explains.

CRS often presents as grade 1 fever that responds to acetaminophen. Moreover, fevers are a good sign that the CAR T-cell therapy is working rather than indicative of a serious toxicity, such as sepsis, Patel explains.

However, in cases of higher-grade fevers that are accompanied by hypoxia or hypotension, tocilizumab (Actemra) can be considered, Patel says. Many patients with COVID-19 were treated with tocilizumab, which led to a shortage of the agent for patients with multiple myeloma receiving CAR T-cell therapy. As such, other options to treat CRS were utilized, including dexamethasone and IL-6 inhibitors like siltuximab (Sylvant), which elicited rapid responses, Patel concludes.