Grading of cytokine release syndrome associated with the CAR T cell therapy tisagenlecleucel.

Abstract

BACKGROUND:

Anti-CD19 CAR T cell therapy has demonstrated high response rates in patients with relapsed or refractory (r/r) B cell malignancies but is associated with significant toxicity. Cytokine release syndrome (CRS) is the most significant complication associated with CAR T cell therapy, and it is critical to have a reproducible and easy method to grade CRS after CAR T cell infusions.

DISCUSSION:

The Common Terminology Criteria for Adverse Events scale is inadequate for grading CRS associated with cellular therapy. Clinical experience with the anti-CD19 CAR T cell therapy tisagenlecleucel at the University of Pennsylvania (Penn) was used to develop the Penn grading scale for CRS. The Penn grading scale depends on easily accessible clinical features; does not rely on location of care or quantitation of supportive care; assigns grades to guide CRS management; distinguishes between mild, moderate, severe, and life-threatening CRS; and applies to both early-onset and delayed-onset CRS associated with T cell therapies. Clinical data from 55 pediatric patients with r/r B cell acute lymphoblastic leukemia and 42 patients with r/r chronic lymphocytic lymphoma treated with tisagenlecleucel were used to demonstrate the current application of the Penn grading scale.

CONCLUSION:

We show that the Penn grading scale provides reproducible CRS grading that can be useful to guide therapy and that can be applied across clinical trials and treatment platforms.

• Authors: David Porter, Noelle Frey, Patricia A Wood, Yanqiu Weng, Stephan A Grupp
• Journal: Journal of hematology & oncology (J Hematol Oncol) Vol. 11 Issue 1 Pg. 35 (03 02 2018) ISSN: 1756-8722 [Electronic] England
• PMID: 29499750 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Cytokines
• Receptors, Antigen, T-Cell
• tisagenlecleucel

Topics

• Animals
• Cytokines (immunology)
• Humans
• Immunotherapy, Adoptive (adverse effects, methods)
• Inflammation (diagnosis, etiology, immunology)
• Leukemia, B-Cell (immunology, therapy)
• Leukemia, Lymphocytic, Chronic, B-Cell (immunology, therapy)
• Receptors, Antigen, T-Cell (therapeutic use)