Leandra Nascimento Fonseca

Brazil

CAR-T Cell Therapy Applied to Onco-Hematology and Probable Adverse Effects

1- Leandra Nascimento Fonseca (lfonsecabiomed@gmail.com)1
1. Undergraduate student of Biomedicine at Cesumar University, participant in PVIC/ICETI-UniCesumar and the GEPIS Research Group.

Abstract

Background

The treatment of hematologic and lymphatic cancers, due to the proliferative dynamics of the disease, represents a challenge. CAR-T CD19 cell therapy has brought hope to relapsed and refractory patients, demonstrating efficiency mainly in cases where conventional therapies have failed. This study conducted a literature review identifying the main adverse effects of this therapy in Diffuse Large B-Cell Lymphoma (DLBCL), a type of non-Hodgkin lymphoma that accounts for about 30% of cases. Although it has a high cure rate, about one-third of patients do not respond well to conventional treatment, with negative outcomes one year after relapse.

Methods

A literature review was conducted in the PubMed and LILACS databases using the MeSH terms “Lymphoma, Large B-Cell, Diffuse” and “CAR-T”. A total of 51 clinical studies published in the last five years were identified. These studies address the treatment of DLBCL with CAR-T CD19, highlighting the main adverse effects.

Results

The main adverse effects identified were Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS). The symptoms of CRS include high fever, headaches, muscle and joint pain, nausea, fatigue, and skin rashes, while ICANS symptoms include mental confusion, seizures, and cerebral edema. Tumor antigen escape is also a significant challenge, leading to tumor resistance.

Conclusions

Understanding the challenges of CAR-T therapy is crucial for developing strategies that enhance its efficacy and safety in treating oncological diseases. Despite their severity, these adverse effects are clinically manageable through meticulous monitoring and strategies such as IL-6 receptor blockade, the use of corticosteroids for CRS, and anticonvulsants. To combat antigen escape, bispecific CARs and bispecific T-cell engagers (BiTEs) are promising. The therapy has shown efficiency in hematologic and lymphatic cancers, providing stable remission. Ongoing studies and promising strategies aim to overcome these limitations and improve clinical outcomes.