Böll Boris, Borrega Jorge Garcia, Schellongowski Peter, Subklewe Marion, von Bergwelt-Baildon Michael
Dtsch Med Wochenschr. 2019 Sep;144(19):1342-1347. doi: 10.1055/a-0853-4689. Epub 2019 Sep 26.
CAR-T cells, genetically modified tumor-targeted t-cells, revolutionized the treatment of refractory B-cell malignancies. CAR-T cell treatment however, is invariably associated with severe immune-mediated toxicities, namely Cytokine Release Syndrome (CRS) and neurological toxicity (CRES/ICANS). Although knowledge on the pathomechanism of these toxicities is still very limited, recent findings including mouse models might allow prediction, earlier recognition and targeted treatment of patients suffering from these potentially life-threatening side effects. This article summarizes current knowledge and recent findings on the management of severe CAR-T associated toxicities and gaps of knowledge stressing the importance of an interdisciplinary approach including hematology-oncology and Intensive Care Medicine.
嵌合抗原受体T细胞（CAR-T细胞），即经过基因改造的肿瘤靶向性T细胞，彻底改变了难治性B细胞恶性肿瘤的治疗方式。然而，CAR-T细胞治疗总是与严重的免疫介导毒性相关，即细胞因子释放综合征（CRS）和神经毒性（CRES/ICANS）。尽管关于这些毒性发病机制的知识仍然非常有限，但包括小鼠模型在内的近期研究结果可能有助于对患有这些潜在危及生命副作用的患者进行预测、早期识别和靶向治疗。本文总结了关于严重CAR-T细胞相关毒性管理的现有知识和近期研究结果，以及知识空白，强调了包括血液肿瘤学和重症医学在内的多学科方法的重要性。
