Ponnapalli Anoosha, Arora Avneet Kaur, Soubani Ayman O
Division of Pulmonary, Critical Care and Sleep Medicinea, Wayne State University School of Medicine, Detroit, MI, USA.
Division of Pulmonary, Critical Care and Sleep Medicinea, Wayne State University School of Medicine, Detroit, MI, USA.
Respir Med. 2025 Mar;238:107958. doi: 10.1016/j.rmed.2025.107958. Epub 2025 Jan 22.
Chimeric Antigen Receptor (CAR) T-cell therapies represents a major advancement in the treatment of refractory hematologic malignancies, with high remission rates for relapsed B-cell lymphomas and leukemias. However, it is associated with a broad spectrum of potentially life-threatening toxicities, many of which require intensive care unit (ICU) management. Key complications include Cytokine Release Syndrome (CRS) and Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS), as well as severe infections, Immune Effector Cell-associated Hematotoxicity (ICAHT), coagulopathies, and organ dysfunctions resulting from the intense inflammatory response induced by CAR T-cells. Approximately one third of patients undergoing CAR T-cell therapy require ICU admission. Among those patients, CRS is the leading indication. ICANS and sepsis are other major causes of admission to the ICU. This review provides a comprehensive overview of ICU considerations for managing CAR T-cell-related toxicities, covering criteria for ICU admission, approaches to grading and treating complications, and interdisciplinary recommendations to optimize patient outcomes. Enhanced awareness and early intervention are critical in reducing ICU mortality and improving overall survival in patients receiving CAR T-cell therapy.
嵌合抗原受体（CAR）T细胞疗法是难治性血液系统恶性肿瘤治疗领域的一项重大进展，对复发的B细胞淋巴瘤和白血病具有较高的缓解率。然而，它与一系列潜在的危及生命的毒性反应相关，其中许多需要重症监护病房（ICU）进行管理。关键并发症包括细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS），以及严重感染、免疫效应细胞相关血液毒性（ICAHT）、凝血功能障碍和由CAR T细胞诱导的强烈炎症反应导致的器官功能障碍。接受CAR T细胞治疗的患者中约有三分之一需要入住ICU。在这些患者中，CRS是主要的入住指征。ICANS和脓毒症是入住ICU的其他主要原因。本综述全面概述了ICU管理CAR T细胞相关毒性反应的注意事项，涵盖ICU入住标准、并发症分级和治疗方法，以及优化患者预后的多学科建议。提高认识和早期干预对于降低接受CAR T细胞治疗患者的ICU死亡率和改善总体生存率至关重要。
