• Cristina Gutierrez, Anne Rain T Brown, Megan M Herr, Sameer S Kadri, Brian Hill, Prabalini Rajendram, Abhijit Duggal, Cameron J Turtle, Kevin Patel, Yi Lin, Heather P May, Alice Gallo de Moraes, Marcela V Maus, Mathew J Frigault, Jennifer N Brudno, Janhavi Athale, Nirali N Shah, James N Kochenderfer, Ananda Dharshan, Amer Beitinjaneh, Alejandro S Arias, Colleen McEvoy, Elena Mead, R Scott Stephens, Joseph L Nates, Sattva S Neelapu, and Stephen M Pastores.
• Department of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States of America. Electronic address: CGutierrez4@mdanderson.org.
• J Crit Care. 2020 Aug 1; 58: 586458-64.

PurposeA task force of experts from 11 United States (US) centers, sought to describe practices for managing chimeric antigen receptor (CAR) T-cell toxicity in the intensive care unit (ICU).Materials And MethodsBetween June-July 2019, a survey was electronically distributed to 11 centers. The survey addressed: CAR products, toxicities, targeted treatments, management practices and interventions in the ICU.ResultsMost centers (82%) had experience with commercial and non-FDA approved CAR products. Criteria for ICU admission varied between centers for patients with Cytokine Release Syndrome (CRS) but were similar for Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS). Practices for vasopressor support, neurotoxicity and electroencephalogram monitoring, use of prophylactic anti-epileptic drugs and tocilizumab were comparable. In contrast, fluid resuscitation, respiratory support, methods of surveillance and management of cerebral edema, use of corticosteroid and other anti-cytokine therapies varied between centers.ConclusionsThis survey identified areas of investigation that could improve outcomes in CAR T-cell recipients such as fluid and vasopressor selection in CRS, management of respiratory failure, and less common complications such as hemophagocytic lymphohistiocytosis, infections and stroke. The variability in specific treatments for CAR T-cell toxicities, needs to be considered when designing future outcome studies of critically ill CAR T-cell patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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