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 the...

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 CAR-T: ...

Excellent question @Dr. First Last and EXCELLENT thoughtful responses by @Dr. First Last and @Dr. First Last 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/µL, except f...

Personally, I think prophylactic interleukin-1 b- I'm unsure why this is not more popular.

Anakinra is used, but this is a daily shot. Ilaris is a monthly or every 8-week shot, and Arcalyst is weekly. There are many options, and my concern is that anakinra, being such a short half-life, may not be t...