Thursday , June 17 2021

What is cytokine release syndrome (CRS) and how is it managed?



Common symptoms of CRS

  • High temperature
  • Low or high blood pressure
  • Short of breath
  • Fatigue

Each medical treatment involves considering the risk-benefit balance: how much risk the patient is willing to take advantage of. CAR T-cell therapy, a new immunotherapy treatment for multiple myeloma, is no exception. The treatment works by activating part of the patient’s immune system to fight cancer more effectively. “We take T cells out of the blood, use gene therapy to make them professional myeloma killers, and then return them by intravenous infusion or subcutaneous injection,” explains Dr. Thomas Martin, a hematologist-oncologist at the University of California, San Francisco. Medical center. Although CAR T-cell therapy shows great promise in the treatment of multiple myeloma, it also carries some risk in terms of side effects. Fortunately, these side effects can usually be managed well.

CRS: the most common side effect

The most common side effect of CAR T-cell therapy is called cytokine release syndrome (CRS). CRS occurs when activated T cells recognize the antigen of a cancer cell that they are designed to attack. “T cells actually recruit more T cells to get into the environment. They do this by creating chemicals called cytokines to enter the bloodstream and say the equivalent of “Bring the cavalry, bring everyone to this area, let’s go kill this thing now!” Dr. Martin explains.

The problem is that these chemicals can flood the system. “We see this in the first one to three days after the infusion of the altered T cells,” says Dr. Martin. “The cells go to the area where it is myeloma and grow and expand very quickly. So, within 24 to 72 hours, most people have symptoms of CRS. These symptoms include a fever of 101 to 103 degrees. And they may have low blood pressure or high blood pressure and difficulty breathing. Most patients feel tired. It seems to me that you have a bad infection. “

Other possible symptoms of CRS include headache, chills, scratching of the throat, nausea, vomiting, diarrhea, and muscle or joint pain. In addition, CRS can cause a fast heartbeat. All these symptoms are caused by new T cells that create a storm in the body.

How to treat CRS

Most people who develop CRS will have mild to moderate symptoms, but sometimes CRS can be serious and even life-threatening. When symptoms occur, doctors closely monitor their patients to make sure they are being managed effectively.

“If the symptoms are mild – which means that the temperature may rise, but the blood pressure is fine and there is no change in the oxygen saturation in the blood – then we can usually only give acetaminophen (Tylenol) to control the fever,” says Dr. Martin. “But if the oxygen level drops a little in the blood, some people will need oxygen support either through a nasal cannula mask or a face mask. Or if the blood pressure drops a little, we give fluids or medicines for that. “

The drugs most commonly used to fight moderate to severe CRS are called tocilizumab, or “toci” for short. “Toci is a drug that tries to rule out this really big storm of cytokines and is quite effective in most people,” says Dr. Martin. CRS symptoms usually last from four to seven days.

The benefits outweigh the risks

CRS is not the only side effect associated with CAR T-cell therapy. Patients may have neurological events that may include brain injury or impairment, confusion, aphasia (difficulty understanding or speaking), drowsiness, anxiety, seizures, loss of balance, and altered consciousness. Treatment can also reduce the number of white or red blood cells. Most of these side effects will resolve on their own or can be managed with medication. But patients should always inform their doctor or care team if they have side effects from treatment.

Although CRS can be serious, it can be managed. “We see it in 70 to 90 percent of patients with CAR T-cell therapy, but we know it comes and we know how to manage it,” says Dr. Martin. And when it’s over, he says, “what we hope is that you’ve had a good anti-cancer effect.”


Learn more about SurvivorNet’s rigorous medical examination.


Dr. Thomas Martin is a clinical professor of medicine in the Adult Leukemia and Bone Marrow Transplant Program and an associate director of the Myeloma Program at the University of California, San Francisco (UCSF). More

Common symptoms of CRS

  • High temperature
  • Low or high blood pressure
  • Short of breath
  • Fatigue

Each medical treatment involves considering the risk-benefit balance: how much risk the patient is willing to take advantage of. CAR T-cell therapy, a new immunotherapy treatment for multiple myeloma, is no exception. The treatment works by activating part of the patient’s immune system to fight cancer more effectively. “We take T cells out of the blood, use gene therapy to make them professional myeloma killers, and then return them by intravenous infusion or subcutaneous injection,” explains Dr. Thomas Martin, a hematologist-oncologist at the University of California, San Francisco. Medical center. Although CAR T-cell therapy shows great promise in the treatment of multiple myeloma, it also carries some risk in terms of side effects. Fortunately, these side effects can usually be managed well.

CRS: the most common side effect

The most common side effect of CAR T-cell therapy is called cytokine release syndrome (CRS). CRS occurs when activated T cells recognize the antigen of a cancer cell that they are designed to attack. “T cells actually recruit more T cells to get into the environment. They do this by creating chemicals called cytokines to enter the bloodstream and say the equivalent of “Bring the cavalry, bring everyone to this area, let’s go kill this thing now!” Dr. Martin explains.

More

The problem is that these chemicals can flood the system. “We see this in the first one to three days after the infusion of the altered T cells,” says Dr. Martin. “The cells go to the area where it is myeloma and grow and expand very quickly. So, within 24 to 72 hours, most people have symptoms of CRS. These symptoms include a fever of 101 to 103 degrees. And they may have low blood pressure or high blood pressure and difficulty breathing. Most patients feel tired. It seems to me that you have a bad infection. “

Other possible symptoms of CRS include headache, chills, scratching of the throat, nausea, vomiting, diarrhea, and muscle or joint pain. In addition, CRS can cause a fast heartbeat. All these symptoms are caused by new T cells that create a storm in the body.

How to treat CRS

Most people who develop CRS will have mild to moderate symptoms, but sometimes CRS can be serious and even life-threatening. When symptoms occur, doctors closely monitor their patients to make sure they are being managed effectively.

“If the symptoms are mild – which means that the temperature may rise, but the blood pressure is fine and there is no change in the oxygen saturation in the blood – then we can usually only give acetaminophen (Tylenol) to control the fever,” says Dr. Martin. “But if the oxygen level drops a little in the blood, some people will need oxygen support either through a nasal cannula mask or a face mask. Or if the blood pressure drops a little, we give fluids or medicines for that. “

The drugs most commonly used to fight moderate to severe CRS are called tocilizumab, or “toci” for short. “Toci is a drug that tries to rule out this really big storm of cytokines and is quite effective in most people,” says Dr. Martin. CRS symptoms usually last from four to seven days.

The benefits outweigh the risks

CRS is not the only side effect associated with CAR T-cell therapy. Patients may have neurological events that may include brain injury or impairment, confusion, aphasia (difficulty understanding or speaking), drowsiness, anxiety, seizures, loss of balance, and altered consciousness. Treatment can also reduce the number of white or red blood cells. Most of these side effects will resolve on their own or can be managed with medication. But patients should always inform their doctor or care team if they have side effects from treatment.

Although CRS can be serious, it can be managed. “We see it in 70 to 90 percent of patients with CAR T-cell therapy, but we know it comes and we know how to manage it,” says Dr. Martin. And when it’s over, he says, “what we hope is that you’ve had a good anti-cancer effect.”

Learn more about SurvivorNet’s rigorous medical examination.


Dr. Thomas Martin is a clinical professor of medicine in the Adult Leukemia and Bone Marrow Transplant Program and an associate director of the Myeloma Program at the University of California, San Francisco (UCSF). More


Source link