Mitigating Cytokine Release Syndrome in CAR T for Multiple Myeloma: Krina K. Patel, MD, MSc

This content originally appeared on our sister site, OncLive.

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

Patel discussed key toxicities seen with CAR T-cell therapy, such as CRS and neurotoxicity in lymphoma and multiple myeloma. CRS is the largest concern in multiple myeloma, Patel said. These toxicities are limiting factors in CAR T-cell therapy use in hematologic malignancies.

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.