Nina Shah, MD, on the Safety and Efficacy of CAR T-Cell Therapies for Multiple Myeloma


The associate professor of clinical medicine discussed the main side effects of CAR T-cell therapies when treating multiple myeloma, and how to combat them.

Nina Shah, MD, associate professor of clinical medicine at the University of California, San Francisco, spoke about the safety and efficacy of chimeric antigen receptor (CAR) T-cell therapies for treating multiple myeloma at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida, from December 7-10, 2019. 


Many people think that it’s difficult to implement CAR T if you’re worried about safety. One of the side effects, or the 3 main side effects actually of CAR T(-cell) therapy, is:

1.     cytokine release syndrome, or CRS, which basically feels like a really bad flu;

2.     neurotoxicity; and

3.     low blood counts. 

And all of these can be severe, but in general they’ve been well controlled in the myeloma population. I think the reason for that is really because we have been able to gain from the experience of our CD19 experience and learn how to manage CRS. We now know that giving tocilizumab (Actemra) isn’t a bad thing and it’s not going to cause the cells to be less effective, and so people are more used to giving that. We also know that at the first sign of neurotoxicity, it’s probably best to start the dexamethasone (Ozurdex), because we really want to air on the side of patient safety and not worry about the cells so much. In addition, since we now know that patients have low blood counts, some of them, even a month or two out from the CAR T(-cell therapy), we have to make sure we monitor them closely. And when they’re sent back to the community doctors, we have to inform the community doctors that this could persist and have a plan to address it and make sure there’s good infection prophylaxis. 

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