What is your management approach for CAR-T induced motor neurologic deficits (cyclophosphamide/IVIG/steroids, etc.) and any prophylactic approach to an early, rapid rise in absolute lymphocyte count post CAR-T infusion?  

Specifically, this seems to be a question around cilta-cel. There has been some recent guidance to consider pre-emptively starting dexamethasone if the absolute lymphocyte count rises above 3,000 in the period following CAR T administration. This partially stems from the observation that many of th...

I don't think there is prospective data, and the SITC guidelines don't address this pertinent question.As a group, we've discussed this, but have not settled on a standard yet. One consideration is absolute lymphocyte count (ALC) monitoring in hopes of neurotoxicity mitigation: Days 2-7 post C...

Excellent question @Saurabh Zanwar and EXCELLENT thoughtful responses by @Ben Derman and @Craig C. Hofmeister about how they are traversing this data-free zone. I will admit that we are using an ALC of 5000 cells/µL for our preemptive-dexamethasone cutoff at the moment and not 3000 cells/&micr...

I would consider prophylactic anti-IL1 blockade - like Ilaris, Acalyst, and anakinra. I think this could help a lot. Park et al., Blood, 2023 Oliai et al., ASCO, 2021