Dr. Shah on Managing CAR T-Cell Therapy–Related Toxicities in Multiple Myeloma

Nina Shah, MD, a hematologist and oncologist, associate professor of medicine, Department of Medicine, at the University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discusses the management of CAR T-cell therapy–related toxicities in multiple myeloma.

Extrapolating data from the CD19-directed CAR T-cell therapy experience in other hematologic malignancies, management of CAR T-cell therapy–related cytokine release syndrome (CRS) and neurotoxicity in patients with multiple myeloma has been relatively straightforward, says Shah.

CRS occurs in 80% to 90% of patients with multiple myeloma treated with CAR T-cell therapy but tends to be low grade and manageable with acetaminophen, supportive care, or tocilizumab (Actemra), says Shah. Moreover, the addition of tocilizumab is not associated with worse outcomes, Shah adds.

Immune effector cell-associated neurotoxicity occurs in about 20% of patients with multiple myeloma treated with CAR T-cell therapy, says Shah. Neurotoxicity can also be treated with steroids, but early recognition is key in ensuring patients are able to overcome the toxicity, Shah explains. As such, The American Society for Transplantation and Cellular Therapy Consensus Grading system should be considered a vital part of supportive care rather than a research tool to ensure neurotoxicity is detected early, concludes Shah.