Ortí Guillermo, Dachy Guillaume, Graham Charlotte E, Peric Zinaida, Alarcon Ana, Del Bufalo Francesca, Doglio Matteo, Henter Jan-Inge, Roddie Claire, Stewart Orla, Van de Donk W C J, Velasco Roser, Aljurf Mahmoud, Ruggeri Annalisa, Onida Francesco, Sánchez-Ortega Isabel, Yakoub-Agha Ibrahim, Penack Olaf
Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain.
Hematology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Bone Marrow Transplant. 2025 Apr 9. doi: 10.1038/s41409-025-02567-5.
CAR T-cell therapies have revolutionized the treatment of hematologic malignancies; however, alongside the well-known complications of cytokine release syndrome (CRS), neurotoxicity, immune effector cell-associated hematotoxicity (ICAHT), and infections, other non-classical toxicities are emerging. This review, developed by the EBMT Practice Harmonization and Guidelines Committee, addresses the management of other critical post-CAR T-cell complications including hemophagocytic lymphohistiocytosis (HLH), graft-versus-host disease (GvHD), thrombotic microangiopathy (TMA), coagulation disorders and secondary malignancies. These complications, though less frequent, present a significant challenge, often contributing to morbidity and mortality with no standardized management protocols. This review provides best practice recommendations for early identification, risk mitigation, and therapeutic interventions, supported by limited but emerging clinical evidence. Comprehensive expert guidance is essential for optimal management of these under-explored toxicities following CAR T-cell therapies.
嵌合抗原受体（CAR）T细胞疗法彻底改变了血液系统恶性肿瘤的治疗方式；然而，除了细胞因子释放综合征（CRS）、神经毒性、免疫效应细胞相关血液毒性（ICAHT）和感染等众所周知的并发症外，其他非典型毒性也日益显现。本综述由欧洲血液与骨髓移植协会（EBMT）实践协调与指南委员会编写，探讨了CAR T细胞治疗后其他关键并发症的管理，包括噬血细胞性淋巴组织细胞增生症（HLH）、移植物抗宿主病（GvHD）、血栓性微血管病（TMA）、凝血障碍和继发性恶性肿瘤。这些并发症虽然不太常见，但构成了重大挑战，常常导致发病和死亡，且尚无标准化的管理方案。本综述提供了早期识别、风险缓解和治疗干预的最佳实践建议，这些建议得到了有限但不断涌现的临床证据的支持。全面的专家指导对于CAR T细胞治疗后这些未充分探索的毒性的最佳管理至关重要。
