CAR-T cell therapy

Question 1

Basic process

Answer 1

T-cells engineered/modified to recognize cancer cells –> grown and cultured –> lymphodeplete pt (prevent rejection) –> infuse into patients

Question 2

Medication used for lymphodepletion

Answer 2

Cytarabine, cytoxan

Question 3

most important SE’s to know about

Answer 3

• cytokine release syndrome
• neurotoxicity (can be delayed)
• HLH/MAS
• B-cell aplasia leading to hypogammaglobulinemia
• infections (during lymphodepletion)
• TLS
• prolonged cytopenia

Question 4

Problem you don’t want to have if other providers are unaware of CAR-T

Answer 4

Patients get transfused high dose steroids and you kill engineered cells

Question 5

vector delivery

Answer 5

viral

Question 6

CAR-T products available

Answer 6

kymriah
yescarta
tecartus
one other

Question 7

management of hypogammaglobulinemia resulting from CAR-T

Answer 7

IF infection –> IVIG

Question 8

most common toxicity of cellular immunotherapy

Answer 8

CRS

Question 9

variables involved in CRS grading

Answer 9

fever
hypotension
hypoxia

Question 10

second line treatment of CRS

Answer 10

Anakinrah

Question 11

first line treatment of CRS

Answer 11

tocilizumab

Question 12

second most common SE of CAR-T

Answer 12

neurotoxicity

Question 13

Neurotoxicity presentation

Answer 13

anything (seizure, HA, encephalopathy, delirium)

Question 14

Term for encephalopathy stemming from CAR-T

Answer 14

Immune effector cell-associated encephalopathy

Question 15

Outpatient CAR-T?

Answer 15

Depends on product

Question 16

Kymriah generic name

Answer 16

Tisagenlecleucel

Question 17

CAR T approved indications

Answer 17

1) relapsed or refractory B cell ALL
2) relapsed or refractory DLBCL
3) high grade B cell lymphoma
4) DLBCL arising from follicular lymphoma
5) High grade follicular lymphoma
6) Relapsed or refractory multiple myeloma
7) relapsed or refractory MCL

Question 18

Target of idecabtagene vicleucel

Answer 18

BCMA