CD19-CART (Shanghai Children's Medical Center)

Remission rate of newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) based on chemotherapy was high; however, recurrence and refractory diseases still affect long-term survival, especially in adult patients. Chimeric antigen receptor T-cell (CAR-T cell) therapy is an important salvage treatment for patients with relapsed/refractory B-ALL, and it significantly improves the response rate, response quality, and survival of such patients. The mechanism and adverse reactions of CAR-T cellular therapy differed from those of traditional chemotherapy, molecular targeted drugs, antibody drugs, etc. Further, it has unique and, in some cases, more serious adverse reactions, despite its relatively high remission rate. Strengthening the full-process management of CAR-T cellular therapy helps achieve higher efficacy with better safety. The article takes one patient with relapsed/refractory B-ALL treated with CD19 CAR-T at our center as an example, and introduces the full-process management strategy of CAR-T cellular therapy, including patient selection, bridging therapy, lymphodepletion treatment, and adverse reaction management.

This study aims to evaluate the impact of levetiracetam (LVT) prophylaxis on the incidence and severity of immune effector cell–associated neurotoxicity syndrome (ICANS) in patients undergoing anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy for LBCL (large B-cell lymphoma). A propensity score–matched cohort of 254 patients was analyzed, comparing those receiving LVT prophylaxis (LTV-yes) with those not receiving it (LTV-no), in a 1:1 ratio. The results showed no significant difference in the occurrence of ICANS of any grade between the 2 groups (32.3% in LVT-no vs 37.1% in LVT-yes; P = .29), or in severe ICANS (grades 2-4, 15.1% vs 16.1% [P = .80]; grade 3-4, 7.9% vs 9.7% [P = .71]). The use of LVT was associated with a higher incidence of early immune effector cell–associated hematotoxicity (ICAHT), with grade 2 to 4 ICAHT occurring in 37.3% vs 63.9% (P < .001) of patients in the LVT-no and LVT-yes groups, respectively. Overall survival and progression-free survival did not differ significantly between the 2 groups (P = .337 and .670). Nonrelapse mortality rates were comparable (P = .77). These findings suggest that routine use of LVT as prophylaxis for ICANS in CAR-T therapy is not effective, and further research is needed to refine its role in selected populations or after ICANS treatment.