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...
I would consider prophylactic anti-IL1 blockade - like Ilaris, Acalyst, and anakinra. I think this could help a lot.