CAR-T-Zellen: Praktische Aspekte der Anwendung einer innovativen Zelltherapie

Immer mehr Patienten mit therapierefraktären B-Zell-Neoplasien in Deutschland werden mit CAR-T-Zellen behandelt. Die Zelltherapie ermöglicht bisher ungekannte Therapieerfolge, ist jedoch auch mit einer Reihe spezifischer Nebenwirkungen assoziiert. Zusätzlich stellt sie als personalisierte Tumortherapie besondere Anforderungen an die Patientenlogistik. Im folgenden Beitrag wird erläutert, worauf in der Versorgung von CAR-T-Zell-Patienten besonders zu achten ist.

Abstract

CD19 CAR T cells induce – in part long-lasting – remissions in heavily pretreated patients with relapsed/refractory B-cell malignancies. However, they are associated with unique toxicities, and patient management therefore requires specific expertise.

In this review, we outline the basics of their mode of action and present the currently available data on their efficacy in various B-cell and plasma cell malignancies. Currently approved therapies (Tisagenlecleucel, Axicabtagene ciloleucel, Brexucabtagene autoleucel) for patients are outlined as well as indications where approvals are expected in the near future. We discuss practical aspects of CAR T cell therapy from the patient’s initial presentation, over leukapheresis, to CAR T cell transfusion. Additionally, we highlight the pathophysiology and principles of the management of the most common toxicities (cytokine release syndrome [CRS], immune cell associated neurotoxicity syndrome [ICANS] and cytopenias).

Schlüsselwörter

CAR-T-Zellen - Immuntherapie - Onkologie - Nebenwirkungen

Key words

CAR-T cells - immunotherapy - oncology - side effects

Publication History

Article published online:
26 August 2021

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