Post CAR T-Cell Therapy Care: Monitoring and Toxicity Management

Auteurs-es

  • Justine Lai
  • Peng Wang
  • Michael Chu

Résumé

CAR T-cell therapy has been highly effective in treating hematologic malignancies that have historically been challenging to manage; however, it is associated with unique and potentially life-threatening toxicities that require specialized care. Advancements in toxicity grading, clinical protocols, and early intervention strategies have reduced the severity of adverse events. As CAR T-cell therapy moves into earlier lines of treatment, the development of reliable predictive biomarkers and algorithm-driven strategies for toxicity prevention will be critical, particularly to support the safe expansion of outpatient CAR T-cell delivery.

Biographies de l'auteur-e

Justine Lai

Justine Lai completed her PhD in hematology at the University of Alberta under the supervision of Dr. Peng Wang and Dr. Joseph Brandwein, where her research focused on the role of cancer stem cells in acute myeloid leukemia relapse. Following her PhD program, she undertook postdoctoral research with Dr. Michael Chu, investigating the development of cellular therapies for the treatment of multiple myeloma. She is currently a medical student at the University of Alberta.

Peng Wang

Dr. Peng Wang is a clinician-translational scientist at the Cross Cancer Institute and University of Alberta Hospital. He completed his PhD at the University of Alberta, where his research focused on developing novel genetic therapies targeting apoptotic pathways in cancer. Dr. Wang subsequently completed his Internal Medicine residency, Hematology subspecialty training, and advanced Leukemia Fellowship at the University of Alberta. Clinically, Dr. Wang specializes in the care of patients with leukemia, lymphoma, and other hematologic malignancies. He is actively involved in both inpatient and outpatient hematology programs, with a particular interest in advancing innovative therapeutic approaches for patients with high-risk and treatment resistant blood cancers. Academically, Dr. Wang's research focuses on basic, translational, and clinical cancer research. His laboratory investigates the molecular mechanisms underlying chemotherapy resistance in leukemia and lymphoma, with the goal of identifying novel therapeutic targets and improving patient outcomes. His work also emphasizes immunotherapy, including monoclonal antibody therapies and cellular therapies in hematologic malignancies. As part of the Alberta Cellular and Immunotherapy Program, he is actively involved in advancing cellular therapy research and the development of innovative treatment strategies for patients with relapsed and refractory cancers. Dr. Wang maintains a broad clinical research portfolio and serves as both principal investigator and sub-investigator on multiple Phase I, II, and III clinical trials. His research program spans translational laboratory studies, investigator-initiated clinical research, and collaborative multicenter trials aimed at improving outcomes for patients with leukemia and lymphoma. In addition to his clinical and research activities, Dr. Wang is actively involved in medical education and mentorship. He supervises graduate trainees and provides teaching for medical students, residents, hematology fellows, and oncology trainees through both didactic instruction and bedside teaching. He is committed to fostering the next generation of clinician-scientists and advancing excellence in hematology research and patient care.

Michael Chu

Dr. Michael Chu is a clinician scientist at the Cross Cancer Institute. He completed his medical training including General Internal Medicine residency and Medical Oncology fellowship at the University of Alberta. Dr. Chu was then awarded a Leukemia and Lymphoma Society fellowship for a combined clinical and research fellowship at Stanford University. Upon returning to Edmonton, his clinical focus includes lymphoma and myeloma. Academically, his research focuses on basic and translational cancer research with an emphasis on immune therapy (including monoclonal antibodies and cellular therapy) including one of the first point of care manufactured CAR T-cells in Canada. He also has a wide range of clinical research where he serves as principal investigator and sub-principal investigator on multiple phase I, II, and III clinical trials. Dr. Chu is actively involved in trainee education particularly with the local Medical Oncology fellows providing both didactic and bedside teaching. When not working hard at the Cross Cancer Institute, Dr. Chu is also a loving husband and father while maintaining his interests in various hobbies including basketball, photography, and piano.

Références

Cappell KM, Kochenderfer JN. Long-term outcomes following CAR T cell therapy: what we know so far. Nat Rev Clin Oncol. 2023;20(6):359–71. doi:10.1038/ s41571-023-00754-1

Ayala Ceja M, Khericha M, Harris CM, Puig-Saus C, Chen YY. CAR-T cell manufacturing: Major process parameters and next-generation strategies. J Exp Med. 2024;221(2):e20230903. doi:10.1084/ jem.20230903

Amini L, Silbert SK, Maude SL, Nastoupil LJ, Ramos CA, Brentjens RJ, et al. Preparing for CAR T cell therapy: patient selection, bridging therapies and lymphodepletion. Nat Rev Clin Oncol. 2022;19(5):342 55. doi:10.1038/s41571-022-00607-3

Jayaraman J, Mellody MP, Hou AJ, Desai RP, Fung AW, Pham AHT, et al. CAR-T design: Elements and their synergistic function. EBioMedicine. 2020;58:102931. doi:10.1016/j.ebiom.2020.102931

Shabaneh TB, Stevens AR, Stull SM, Shimp KR, Seaton BW, Gad EA, et al. Systemically administered low-affinity HER2 CAR T cells mediate antitumor efficacy without toxicity. J Immunother Cancer. 2024;12(2):e008566. doi:10.1136/jitc-2023-008566 6.

Gilead Sciences Canada Inc. Yescarta (axicabtagene ciloleucel): product monograph. Mississauga (ON): Gilead Sciences Canada Inc.; 2025 Jun 24. Novartis Pharmaceuticals Canada Inc. Kymriah (tisagenlecleucel): product monograph. Montreal (QC): Novartis Pharmaceuticals Canada Inc.; 2024 Oct 29.

Bristol-Myers Squibb Canada. Breyanzi (lisocabtagene maraleucel): product monograph. Saint-Laurent (QC): Bristol-Myers Squibb Canada; 2025 Oct 3.6.

Gilead Sciences Canada Inc. Tecartus (brexucabtagene autoleucel): product monograph. Mississauga (ON): Gilead Sciences Canada Inc.; 2025 Jun 26.

Janssen Inc. Carvykti (ciltacabtagene autoleucel): product monograph. Toronto (ON): Janssen Inc.; 2026 May 13.

The University of Texas MD Anderson Cancer Center. IEC therapy toxicity assessment and management (CARTOX) – adult. Version 5. 2023.

Gabriel K, Heinzerling L, von Baumgarten L, Subklewe M, Kobold S. The role of cytokines in cytokine release syndrome (CRS) after CAR T cell therapy. Biochim Biophys Acta Mol Cell Res. 2026;1873(3):120115. doi:10.1016/j.bbamcr.2026.120115

Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, et al. ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 2019;25(4):625–38. doi:10.1016/j. bbmt.2018.12.758

Yamshon S, Gribbin C, Alhomoud M, Chokr N, Chen Z, Demetres M, et al. Safety and toxicity profiles of CAR T cell therapy in non-Hodgkin lymphoma: A systematic review and meta-analysis. Clin Lymphoma Myeloma Leuk. 2024;24(6):e235-e256.e2. doi:10.1016/j.clml.2024.02.007

Tedesco VE, Mohan C. Biomarkers for predicting cytokine release syndrome following CD19-targeted CAR T cell therapy. J Immunol. 2021;206(7):1561–8. doi:10.4049/jimmunol.2001249

Greenbaum U, Strati P, Saliba RM, Torres J, Rondon G, Nieto Y, et al. CRP and ferritin in addition to the EASIX score predict CAR-T-related toxicity. Blood Adv. 2021;5(14):2799–806. doi:10.1182/ bloodadvances.2021004575

Zandaki D, Selukar S, Bi Y, Li Y, Zinsky M, Bonifant CL, et al. EASIX and m-EASIX predict CRS and ICANS in pediatric and AYA patients after CD19-CAR T-cell therapy. Blood Adv. 2025;9(2):270–9. doi:10.1182/ bloodadvances.2024014027

Ying Z, Song Y, Zhu J. Effectiveness and safety of anti CD19 chimeric antigen receptor-T cell immunotherapy in patients with relapsed/refractory large B-Cell lymphoma: A systematic review and meta-analysis. Front Pharmacol. 2022;13:834113. doi:10.3389/ fphar.2022.834113

Canadian Agency for Drugs and Technologies in Health. Anticytokine therapy and corticosteroids for cytokine release syndrome and for neurotoxicity following T-cell engager or CAR T-cell therapy: rapid review [Internet]. 2024 [cited 2026 Mar 22]. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK604827/

Scott SA, Marin EM, Maples KT, Joseph NS, Hofmeister CC, Gupta VA, et al. Prophylactic tocilizumab to prevent cytokine release syndrome (CRS) with teclistamab: A single-center experience. Blood Cancer J. 2023;13(1):191. doi:10.1038/s41408-023 00963-y

Korst CLBM, Groen K, Bosman PWC, van der Valk F, Verkleij CPM, Kruyswijk S, et al. Prophylactic tocilizumab reduces the incidence of cytokine release syndrome in relapsed/refractory myeloma patients treated with teclistamab: Implications for outpatient step-up dosing. HemaSphere. 2024;8(7):e132. doi:10.1002/hem3.132

Nair R, Peddi A, Gourisetti S, Menon P, Hickman L, Adroja S, et al. Real-world use of prophylactic anakinra to mitigate CRS and ICANS in CAR-T therapy. Transplant Cell Ther. 2026;32(2):S186. doi:10.1016/j.jtct.2025.12.256

Banerjee R, Fakhri B, Shah N. Toci or not toci: innovations in the diagnosis, prevention, and early management of cytokine release syndrome. Leuk Lymphoma. 2021;62(11):2600–11. doi:10.1080/104281 94.2021.1924370

Han MW, Jeong SY, Suh CH, Park H, Guenette JP, Huang RY, et al. Incidence of immune effector cell associated neurotoxicity among patients treated with CAR T-cell therapy for hematologic malignancies: systematic review and meta-analysis. Front Neurol. 2024;15:1392831. doi:10.3389/fneur.2024.1392831

Kennedy LB, Salama AKS. A review of cancer immunotherapy toxicity. CA Cancer J Clin. 2020;70(2):86–104. doi:10.3322/caac.21596

Chou CK, Turtle CJ. Assessment and management of cytokine release syndrome and neurotoxicity following CD19 CAR-T cell therapy. Expert Opin Biol Ther. 2020;20(6):653–64. doi:10.1080/14712598.202 0.1729735.

Santomasso BD, Nastoupil LJ, Adkins S, Lacchetti C, Schneider BJ, Anadkat M, et al. Management of immune-related adverse events in patients treated with chimeric antigen receptor T-cell therapy: ASCO Guideline. J Clin Oncol. 2021;39(35):3978–92. doi:10.1200/JCO.21.01992

Pennisi M, Jain T, Santomasso BD, Mead E, Wudhikarn K, Silverberg ML, et al. Comparing CAR T-cell toxicity grading systems: application of the ASTCT grading system and implications for management. Blood Adv. 2020;4(4):676–86. doi:10.1182/ bloodadvances.2019000952

Grant SJ, Grimshaw AA, Silberstein J, Murdaugh D, Wildes TM, Rosko AE, et al. Clinical presentation, risk factors, and outcomes of immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor T cell therapy: A systematic review. Transplant Cell Ther. 2022;28(6):294–302. doi:10.1016/j.jtct.2022.03.006

Graham CE, Velasco R, Alarcon Tomas A, Stewart OP, Dachy G, Del Bufalo F, et al. Non-ICANS neurological complications after CAR T-cell therapies: recommendations from the EBMT Practice Harmonisation and Guidelines Committee. Lancet Oncol. 2025;26(4):e203–13. doi:10.1016/S1470 2045(24)00715-0

Lim KJC, Tan M, Parrondo R, Chhabra S, Dooley K, De Menezes Silva Corraes A, et al. Clinical course, risk factors and mitigating strategies for Immune effector cell-associated late onset neurotoxicities after ciltacabtagene autoleucel CAR-T in multiple myeloma. Blood Cancer J. 2025;16(1):18. doi:10.1038/s41408 025-01441-3

Jain T, Olson TS, Locke FL. How I treat cytopenias after CAR T-cell therapy. Blood. 2023;141(20):2460–9. doi:10.1182/blood.2022017415

Doan A, Pulsipher MA. Hypogammaglobulinemia due to CAR T-cell therapy. Pediatr Blood Cancer. 2018;65(4). doi:10.1002/pbc.26914

Shahid Z, Jain T, Dioverti V, Pennisi M, Mikkilineni L, Thiruvengadam SK, et al. Best practice considerations by the American Society of Transplant and Cellular Therapy: Infection prevention and management after chimeric antigen receptor T cell therapy for hematological malignancies. Transplant Cell Ther. 2024;30(10):955–69. doi:10.1016/j.jtct.2024.07.018

Hayden PJ, Roddie C, Bader P, Basak GW, Bonig H, Bonini C, et al. Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA). Ann Oncol. 2022;33(3):259–75. doi:10.1016/j. annonc.2021.12.003

Ghilardi G, Fraietta JA, Gerson JN, Van Deerlin VM, Morrissette JJD, Caponetti GC, et al. T cell lymphoma and secondary primary malignancy risk after commercial CAR T cell therapy. Nat Med. 2024;30(4):984–9. doi:10.1038/s41591-024-02826-w

Brudno JN, Maus MV, Hinrichs CS. CAR T cells and T-cell therapies for cancer: A translational science review. JAMA. 2024;332(22):1924–35. doi:10.1001/ jama.2024.19462

Betof Warner A, Hamid O, Komanduri K, Amaria R, Butler MO, Haanen J, et al. Expert consensus guidelines on management and best practices for tumor-infiltrating lymphocyte cell therapy. J Immunother Cancer. 2024;12(2):e008735. doi:10.1136/jitc-2023-008735

Wang JY, Wang L. CAR-T cell therapy: Where are we now, and where are we heading? Blood Sci. 2023;5(4):237–48. doi:10.1097/ BS9.0000000000000173

Tomasik J, Jasiński M, Basak GW. Next generations of CAR-T cells - new therapeutic opportunities in hematology? Front Immunol. 2022;13:1034707. doi:10.3389/fimmu.2022.1034707

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Publié

2026-09-24

Comment citer

1.
Post CAR T-Cell Therapy Care: Monitoring and Toxicity Management. Can Hematol Today [Internet]. 24 sept. 2026 [cité 24 sept. 2026];5(2):37-46. Disponible à: https://canadianhematologytoday.com/article/view/5-2-Lai_et_al

Numéro

Volume 5, Issue 2, Summer 2026

Rubrique

Articles

Licence

© Actualité hématologique au Canada 2026

Licence Creative Commons

Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.

Comment citer

1.
Post CAR T-Cell Therapy Care: Monitoring and Toxicity Management. Can Hematol Today [Internet]. 24 sept. 2026 [cité 24 sept. 2026];5(2):37-46. Disponible à: https://canadianhematologytoday.com/article/view/5-2-Lai_et_al