• Cristina Gutierrez, Anne Rain T Brown, Heather P May, Amer Beitinjaneh, R Scott Stephens, Prabalini Rajendram, Joseph L Nates, Stephen M Pastores, Ananda Dharshan, de MoraesAlice GalloAGDepartment of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN., Matthew K Hensley, Lei Feng, Jennifer N Brudno, Janhavi Athale, Monalisa Ghosh, James N Kochenderfer, Alejandro S Arias, Yi Lin, Colleen McEvoy, Elena Mead, Jason Westin, Natalie Kostelecky, Agrima Mian, and Megan M Herr.
• Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
• Crit. Care Med. 2022 Jan 1; 50 (1): 819281-92.

ObjectivesTo report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome.DesignRetrospective cohort study.SettingNine centers across the U.S. part of the chimeric antigen receptor-ICU initiative.PatientsAdult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019.InterventionsDemographics, toxicities, specific interventions, and outcomes were collected.ResultsOne-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3-4 toxicities (66.7%); 15.2% had grade 3-4 cytokine release syndrome and 64% grade 3-4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64-not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival.ConclusionsThis is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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