CAR T-cell therapy may offer new hope for many people living with multiple myeloma, but understanding the potential side effects is essential. Myeloma expert Dr. Beth Faiman explains the most common risks of CAR T-cell therapy and shares and how advances in care are helping doctors better prevent and manage these potential complications.
Dr. Beth Faiman is an Adult Nurse Practitioner in the Department of Hematologic Oncology and Blood Disorders at the Cleveland Clinic. Learn more about Dr. Faiman.
Related Resources
Transcript
Katherine Banwell:
What about safety? What has changed in regards to risk of potential side effects from CAR T?
Beth Faiman:
Yeah, so, from the earlier 2010s when we starting using clinical trials with CAR T-cell therapy, we had a very well-described side effect profile. Three main things I think of and tell patients. Number one, cytokine release syndrome where we’re stimulating your T cells to be fighters. So, it’s like getting a bad fever. And I compare it to if you get a flu shot or an immunization. Your body is building up immunity. And so, you will sometimes have a fever, but this can be way worse. So, that CRS can be very worrisome. And so, we sometimes bring people into the hospital for that, and we’ll talk about that probably in a few moments.
Neurotoxicity or ICANS, again, it’s called immune cell affecter associated neurotoxicity syndrome. People might have maybe a mild headache, but it could be more severe such as confusion. We know now to give drugs such as dexamethasone to stop that process and turn that off to reverse some of these effects.
And then finally, infection. We know infection because we’re ablating and getting rid of the B cells which are supposed to protect us from getting sick. We know through giving drugs such as intravenous immunoglobulin or IVIG can protect people against serious infections. We now know that everybody should take a medication such as sulfamethoxazole/trimethoprim (Bactrim) to prevent a rare type of pneumonia that some immunocompromised patients get. And we know that we should give you re-vaccines. So, revaccinating like after a stem cell transplant is important. So, again, the CRS, ICANS, and infection are the top three things we worry about.
And we have better knowledge of how to prevent and mitigate those side effects. And that’s what is now recommended through national guidelines.