CAR T-Cell Therapy and Critical Care Considerations

As immunotherapies for cancer become widely used, a new range of complications has made intensive care unit (ICU) staff rethink the way we diagnose, treat and think about the prognosis of critically ill cancer patients. Chimeric antigen receptor (CAR) T-cells for B-cell malignancies provide durable remissions for many patients who had previously faced dismal prognosis. The most common complications that lead to ICU admission in the early stages after cell infusion are cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), hemophagocytic lymphohistiocytosis (HLH) and sepsis. In the long term, these patients develop significant immunosuppression, putting them at a high risk for severe infections. This chapter reviews the most common short- and long-term complications of CAR therapy that lead to ICU admission. A better understanding of these complications and their risk factors can help ICU staff support and care for these patients who can have an excellent prognosis.