Published in Haematologica November 2019 : haematol.2019.229781; Doi:10.3324/haematol.2019.229781
The use of CAR T-cell therapies to treat patients with relapsed acute lymphoblastic leukaemia and relapsed high-grade B-cell lymphoma is increasing rapidly. Tisagenlecleucel (Kymriah) is approved for the treatment of refractory/relapsed Acute Lymphoblastic Leukaemia in children and young adults as well as relapsed/refractory Diffuse Large B-cell Lymphoma. Axicabtagene ciloleucel (Yescarta) is approved for the treatment of relapsed/refractory high-grade B-cell Lymphoma and Primary Mediastinal B-cell Lymphoma. Though often highly effective, this novel therapy class has known toxicities that require careful patient management. An expert group working under the auspices of the European Society of Blood and Marrow Transplantation have worked over the last year to produce guidelines in this rapidly moving field. The “EBMT-JACIE Best Practice Recommendations on the Management of Adults and Children undergoing CAR T-cell therapy” were published online in Haematologica in November 2019. These broad-ranging recommendations relate to patient care and supply chain management under the following headings: patient eligibility, screening laboratory tests and imaging and work-up prior to leukapheresis, how to perform leukapheresis, bridging therapy, lymphodepleting conditioning, product receipt and thawing, infusion of chimeric antigen receptor T-cells, short-term complications including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, antibiotic prophylaxis, medium-term complications including cytopenias and B-cell aplasia, nursing and psychological patient support, long-term follow-up, post-authorisation safety surveillance, and regulatory issues.