A growing number of patients with advanced cancer are able to benefit from treatment with CAR T cell therapy, a “living drug” that involves genetically modifying a patient’s own immune T cells then infusing them back into the body to fight off cancer. The treatment is highly technical, and while it can be a lifesaving option, it also carries with it the risk of potentially serious side effects. Dr. Sid Ganguly, Deputy Director of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Medical Center, explains the risks associated with one of these side effects called “cytokine release syndrome.”
What Causes Cytokine Release Syndrome?
During CAR T cell therapy, when patients receive an infusion of their own immune T cells that have been genetically altered, these T cells will usually begin to attack the cancer cells straightaway. In the process of doing so, they release signaling molecules called “cytokines.” The release of cytokines can cause a number of symptoms and reactions that vary in terms of severity. Because symptoms can range from mild flu-like symptoms to life-threatening reactions, doctors will often refer to different “grades” of cytokine release syndrome.
Grade 1 Cytokine Release Syndrome
Read MoreGrade 2 Cytokine Release Syndrome
If the Tylenol and antibiotics don’t help the patient get better, the cytokine release syndrome may be elevated to grade 2. With grade 2, patients may experience low blood pressure and require more specialized treatment measures, such as oxygen, fluid resuscitation, and low doses of pressors that maintain blood pressure.Grade 3 Cytokine Release Syndrome
Beyond grade 2 cytokine release syndrome, patients often need to be transferred to the intensive care unit and monitored extremely closely.Grade 4 Cytokine Release Syndrome
When cytokine release syndrome reaches stage 4, Dr. Ganguly says, it becomes “really life-threatening and serious.”
“When cytokine release syndrome advances beyond the supportive measures, then we have to use specific treatment,” Dr. Ganguly says. He explains that this may entail an anti-cytokine, which is a medication that counteracts the cytokines, called tocilizumab (Actemra), or steroids, a medication that calms the immune system.
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