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Understanding and Managing Immune Effector Cell �Toxicities in Hematologic Malignancies in 2025�

David Reeves, PharmD, BCOP

​

Professor of Pharmacy Practice

Butler University

​

Clinical Pharmacy Specialist – Hematology/Oncology

Franciscan Health Indianapolis

�

�

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Objectives & Disclosure

​

Disclosure

    • I have no conflicts of interest to disclose
    • All materials and content presented do not infringe or violate any copyright, trademark, patent or intellectual property rights of any person or entity, nor do they promote or endorse any product, service, or device which may or is at the time of the program not approved by any governing agency

Assess the risk for immune effector toxicity associated with therapies for hematologic malignancies

Propose a strategy to manage a patient experiencing immune effector toxicity

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Immune Effector Cell Toxicity

Cytokine Release Syndrome (CRS)

    • Fevers, chills, tachycardia, hypotension, hypoxia, capillary leak, organ dysfunction, hemophagocytic lymphohistiocytosis/ macrophage activation syndrome (HLH/MAS)

​

    • Infused T-cells or activated t-cells, host immune effector cells, and/or vascular endothelial activation result in:
      • Hyperinflammation
      • Overproduction of inflammatory cytokines (IL-6, IL-1, INFγ, TNFα)

Immune Effector Cell –Associated Neurotoxicity Syndrome (ICANS)

    • Encephalopathy, delirium, hallucinations, cognitive defects, tremors, ataxia, dysphasia, nerve palsies, focal motor or sensory deficits, myoclonus, somnolence, obtundation, seizures

​

    • Systemic hyperinflammation affects blood-brain barrier + increased vascular permeability result in:
      • Accumulation of cytokines (IL-6, INFγ, TNFα) host-immune cells, and CAR T-lymphocytes in brain

Blood Reviews. 2019;34:45-55

https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf

https://www.cancersupportcommunity.org/car-t-cell-therapy

Chimeric Antigen Receptor T-Cell (CAR T-cell)

Bispecific T-Cell Engager (BTCE)

Br J Cancer. 2021;124:1037-1048

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Chimeric Antigen Receptor (CAR) T-cell Therapy

https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf

FDA Approved Agents

Target

Indication

(Line of therapy)

Axicabtagene Ciloleucel (Axi-Cel) (Yescarta)

CD19

FL (3), LBCL (2)

Brexucabtagene Autoleucel

(Brexu-Cel) (Tecartus)

ALL (2), MCL (2)

Lisocabtagene Maraleucel

(Liso-Cel) (Breyanzi)

LBCL (2), CLL/SLL (3), FL (3), MCL (3)

Obecabtagene Autoleucel (Obe-Cel) (Aucatzyl)

ALL (2)

Tisagenlecleucel

(Tis-Cel) (Kymriah)

ALL (3), LBCL (3), FL (3)

Ciltacabtagene Autoleucel

(Cilta-Cel) (Carvykti)

BCMA

MM (2)

Idecabtagene Vicleucel (Ide-Cel) (Abecma)

MM (3)

Derived from prescribing information for each medication as of 12/2024

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Bispecific T-Cell Engagers (BTCE)

FDA Approved Agents

Target

Indication

Blinatumomab (Blincyto)

CD 19

ALL w/ MRD, ALL consolidation, r/r ALL

Epcoritamab (Epkinly)

CD20

DLBCL (3rd line), FL (3rd line)

Glofitamab (Columvi)

DLBCL (3rd line)

Mosunetuzumab (Lunsumio)

FL (3rd line)

Elranatamab (Elrexfio)

​

BCMA

MM (5th line)

Teclistamab (Tecvayli)

MM (5th line)

Talquetamab (Talvey)

GPRC5D

MM (5th line)

r/r: relapsed refractory

​

Derived from prescribing information for each medication as of 12/2024

Br J Cancer. 2021;124:1037–1048

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ASTCT Consensus Grading for CRS/ICANS

CRS

Grade 1

Grade 2

Grade 3

Grade 4

Fever

Temp ≥ 38°C

Temp ≥ 38°C

Temp ≥ 38°C

Temp ≥ 38°C

​

WITH

Hypotension

None

Not requiring vasopressors

Requiring a vasopressor w/ or w/o vasopressin

Requiring multiple vasopressors (excluding vasopressin)

​

And/or

Hypoxia

None

Requiring low-flow nasal cannula

Requiring high-flow nasal cannula, facemask, nonrebreather mask, or Venturi mask

Requiring positive pressure (e.g., CPAP, BiPAP, mechanical ventilation)

Biol Blood Marrow Transplant. 2019;25:625-638.

ICANS

Grade 1

Grade 2

Grade 3

Grade 4

ICE Score

7-9

3-6

0-2

0 (unarousable)

Awakens to:

Spontaneously

To voice

Only to tactile stimulus

Unarousable or requires vigorous tactile stimuli. Stupor or coma

Seizure

N/A

N/A

Any clinical seizure that resolves rapidly or nonconvulsive seizures on EEG resolving w/ intervention

Life-threatening prolonged seizure (> 5 min); or Repetitive clinical or electrical seizures without return to baseline in between

Motor Findings

N/A

N/A

N/A

Deep focal motor weakness

Elevated ICP/cerebral edema

N/A

N/A

Focal/local edema on neuroimaging

Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing; or cranial nerve VI palsy; or papilledema; or Cushing’s triad

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Agent Specific Toxicity Rates

​

​

*Includes all neurotoxicity. Rates derived from Prescribing Information for each medication as of 12/2024

CAR T-cell Therapies

Target

Costimulatory domain

CRS

Severe CRS

ICANS

Severe ICANS

Axi-Cel

CD19

CD28

93%

13%

64%

28%

Brexu-Cel

CD28

89-91%

15-24%

60-63%

25-30%

Liso-Cel

4-1BB

42%

2%

30%

10%

Obe-Cel

4-1BB

75%

3%

24%

7%

Tis-Cell

4-1BB

58-77%

22-47%

21-40%

12-13%

Ide-Cel

BCMA

4-1BB

84%

5%

18%

3%

Cilta-Cel

4-1BB

95%

4%

21%

9%

NCCN guidelines: Management of Immunotherapy related toxicities; Cancer Treatment Reviews. 2022;111:102479; Lancet. 2021;398:491-502

Bispecific T-cell Engagers

Oncologic Target

CRS

Severe CRS

ICANS

Severe ICANS

Blinatumomab (Blincyto)

CD 19

15%

5%

65%*

13%*

Epcoritamab (Epkinly)

CD20

51%

2.5%

6%

0.6%

Glofitamab (Columvi)

70%

4.2%

4.8%

2.1%

Mosunetuzumab (Lunsumio)

39%

2.5%

2.1%

<1%

Elranatamab (Elrexfio)

BCMA

58%

0.5%

3.3%

​

Teclistamab (Tecvayli)

72%

0.6%

6%

0%

Talquetamab (Talvey)

GPRC5D

76%

1.5%

9%

​

CAR T-Cell

BTCE

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BTCE Dose Titrations

Blinatumomab

(Continuous IV infusion)

    • Cycle 1: 9 mcg/d x 7 days then 28 mcg/d to complete 28 days
    • Hospitalize x 9 days cycle 1
    • Hospitalize x 3 days for additional cycles

Epcoritamab

(Subcutaneous - LBCL)

    • Day 1: 0.16 mg
    • Day 8: 0.8 mg
    • Day 15: 48 mg**
    • Day 22: 48 mg
    • Cycle 2-3: 48 mg on days 1/8/15/22
    • Cycle 4-9: 48 mg days 1/15
    • Cycle 10+: 48 mg day 1 q28d

Epcoritamab�(Subcutaneous - FL)

    • Day 1: 0.16 mg
    • Day 8: 0.8 mg
    • Day 15: 3 mg
    • Day 22: 48 mg
    • Cycle 2-3: 48 mg on days 1/8/15/22
    • Cycle 4-9: 48 mg on days 1/15
    • Cycle 10+: 48 mg day 1 q28d

Glofitamab

(IV infusion)

    • Day 1: Obinutuzumab
    • Day 8: 2.5 mg over 4h*
    • Day 15: 10 mg over 4 h
    • Every 21 days: 30 mg over 4 h cycle 2 then over 2 h

Mosunetuzumab

(IV Infusion)

    • Day 1: 1 mg over 4 h
    • Day 8: 2 mg over 4 h
    • Day 15: 60 mg over 4 h
    • Cycle 2 Day 1: 60 mg over 2 h
    • Every 21 days: 30 mg over 2 h

Elranatamab

(Subcutaneous)

    • Day 1: 12 mg**
    • Day 4: 32 mg *
    • Day 8: 76 mg
    • Weekly thru week 48: 76 mg
    • Every 2 weeks week 49+: 76mg

Teclistamab

(Subcutaneous)

    • Day 1: 0.06 mg/kg**
    • Day 4: 0.3 mg/kg**
    • Day 7: 1.5 mg/kg
    • Weekly 1.5 mg/kg
    • Every 2 weeks (if CR x 6 mo.): 1.5 mg/kg

Talquetamab

(Subcutaneous)

    • Day 1: 0.01 mg/kg**
    • Day 4: 0.06 mg/kg**
    • Day 7: 0.4 mg/kg**
    • Weekly: 0.4 mg/kg
    • Every 2 weeks: 0.8 mg/kg on day 10 then every 2 weeks

* = 24 hours of hospitalization suggested

Information derived from Prescribing Information for each medication as of 12/2024

Pretreat step up doses with steroid, diphenhydramine, acetaminophen (except blinatumomab, steroid only)

Re-titration may be necessary after prolonged delay

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Timing of CRS & ICANS

​

CRS

CRS Incidence During Titration

ICANS

Onset (Range)

Duration (Range)

Dose 1

Dose 2

Dose 3

Dose 4

Recurrent CRS

Onset

(Range)

Duration (Range)

Blinatumomab

2d

5d

​

​

​

​

​

w/in 1st 2 wks.

​

Epcoritamab (LBCL)

24h (0-10d)

2d (1-27d)

9%

16%

61%*

6%

16%

3d (1-3d)

4d (0-8 d)

Epcoritamab (FL)

59h (0.1-7d)

2d (1-14d)

14%

7%

17%

49

23%

3d (0.4-7d)

2d (1-7d)

Glofitamab

14h (5-74h)

2d (1-14d)

56%*

35%

29%

2.8%^

34%

​

​

Mosunetuzumab

5-46h@

3d (1-21d)

15%

5%

33%

5%

11%

17d (1-48d)

3d (1-20d)

Elranatamab

2d (1-9d)

2d (1-19d)

43%**

19%*

7%

1.6%^

13%

3d (1-4d)

2d (1-18 d)

Teclistamab

2d (1-6d)

2d (1-9d)

42%**

35%**

24%**

<3%^

33%

4d (2-8d)

3d (1-20d)

Talquetamab

27h (0-7d)

17h (0-26d)

29%**

44%**

33%**

12%!

30%

2.5d (1-16d)

2d (1-22 d)

Information derived from Prescribing Information for each medication as of 12/2024

NCCN guidelines: Management of Immunotherapy related toxicities V1.2025

^ all subsequent doses @ onset longer with progressive doses

*24 h of hospitalization recommended ! For the addtl step up dose necessary for biweekly dosing

CRS

    • Onset: 2-3 d
    • Duration: 7-8 d

ICANS

    • Onset: 4-10 d
    • Duration: 14-17 d

CAR T-cell Therapies

​

​

​

​

Bispecific T-cell Engagers

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CRS and ICANS �Mitigation and Management Strategies

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Epcoritamab: EPCORE NHL-1 Optimization

  • Dexamethasone 15 mg
    • Premedication Day 1, 8, 15, 22
    • Days 2-4, 9-11, 16-18, 23-25
  • Hydration
    • 2-3 L fluid intake in 24 hour prior to each dose
    • 500 mL IV on day of each dose
    • 2-3 L intake in 24 h following each dose
  • Hold antihypertensives 24 hours prior to each dose

​

  • Hospitalization not required

Epcoritamab

(Subcutaneous)

    • Day 1: 0.16 mg
    • Day 8: 0.8 mg
    • Day 15: 48 mg**
    • Day 22: 48 mg
    • Cycle 2-3: 48 mg on days 1/8/15/22
    • Cycle 4-9: 48 mg days 1/15
    • Cycle 10+: 48 mg day 1 q28d

Blood. 2023;142(S1):1729

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EPCORE: NHL1 Optimization Results

​

Expansion Cohort

N=157

DLBCL Optimization Cohort

N=36

CRS, %

Grade 1

Grade 2

Grade 3

51

32

16

3

22

14

8

0

Median time to onset after first full dose, h

20

27

Treated with tocilizumab, %

29

38

Treated with corticosteroid, %

21

25

Leading to treatment discontinuation, %

1

0

Median time to resolution, d (range)

2 (1-27)

2.5 (1-6)

Blood. 2023;142(S1):1729

​

Pivotal Cohort

N=128

FL Optimization Cohort

N=86

CRS, %

Grade 1

Grade 2

Grade 3

66

40

25

2

49

40

9

0

ICANS, %

6

0

J Clin Oncol. 2024;42(16S):7015

Diffuse Large B Cell Lymphoma

Follicular Lymphoma

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Obi-Cel Split Infusion Dosing

​

N=127

All grade CRS, %

68.5

Grade 3+ CRS, %

2.4%

Time to CRS, d (range)

8 (1-23)

CRS Duration, d (range)

5 (1-21)

All grade ICANS, %

22.8%

Grade 3 + ICANS, %

7.1%

Time to ICANS, d (range)

12 (1-31)

ICANS Duration, d (range)

8 (1-53)

  • Compared to Brexu-cel for ALL:
    • G3+ CRS: 25% vs 2.4%
    • G3+ ICANS: 30% vs. 7.1%
  • Most ICANS seen with high BM burden
    • Ambulatory administration if low bone marrow burden?
  • Timing of CRS and ICANS varied from other products

​

​

N Engl J Med 2024;391:2219-2230

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NCCN Guidelines Pre/Post CAR T-Cell Monitoring

Before and During CAR T-Cell Infusion

Baseline cardiac assessment (i.e., echocardiogram)

Tumor lysis prophylaxis and monitoring (large tumor burden and aggressive histology)

Seizure prophylaxis on day of infusion

  • Levetiracetam 500 – 750 mg PO every 12 hours for 30 days

Baseline neurologic exam

  • ICE score
  • Consider baseline brain MRI

Baseline CRP and ferritin

Post CAR T-Cell Infusion

Hospitalization or extremely close outpatient monitoring

Hospitalization at first sign of CRS or neurotoxicity

CBC, CMP, coagulation profile daily

CRP and serum ferritin 3x/week for 2 weeks

  • Consider daily during CRS

Vitals every 8 hours x 1-2 weeks

Neurotoxicity assessment twice daily until hospital discharge and routinely every 2-4 weeks x 2 months

Monitor for CRS, neurotoxicity, and other toxicities for at least 4 weeks (and up to 3-6 months)

Refrain from driving/hazardous activities x 8 weeks*

*Physician survey presented at ASH 2024 demonstrated most recommend driving restrictions for 4 weeks while 78% disagreed with driving restrictions in weeks 4-8

​

Blood. 2024;144(S1);3765

NCCN guidelines: Management of Immunotherapy related toxicities V1.2025

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Immune Effector Toxicity Management Overview

  • Immunosuppression to counter overactive immune effector cells and increased cytokine levels

Tocilizumab

    • Humanized IgG1κ anti-IL6R antibody
    • Binds both soluble and membrane-bound IL-6R
    • Insufficient CNS penetration
    • May increase CSF IL-6 levels
    • Generally limited to 2 doses during a CRS episode

Corticosteroids

    • CONCERN – higher doses could suppress CAR T-cell expansion and persistence
    • Detrimental impact on efficacy not supported in most studies
    • Dexamethasone may be preferred for ICANS due to better CNS penetration
    • Rapid taper once symptoms begin to improve

Anakinra

    • Interleukin 1 Receptor antagonist
    • Increasing data
    • Consider in patients with tocilizumab refractory CRS or steroid refractory ICANS

Supportive Care

    • Antipyretics
    • IV hydration
    • Vasopressors
    • Seizure prophylaxis (i.e., levetiracetam)

​

*Prophylactic steroids may be considered for axi cel (dexamethasone 10 mg PO daily x 3 days)

NCCN guidelines: Management of Immunotherapy related toxicities V1.2025

J Clin Oncol. 2021;39:3978-92

CAR-T Corticosteroid prophylaxis*

CAR-T Anakinra prophylaxis if high risk for CNS toxicity

Teclistamab Tocilizumab Prophylaxis

Emerging Prophylaxis Strategies

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Grade 1

    • Tocilizumab for prolonged CRS (>72 h)
    • Consider dexamethasone for early onset CRS (<72 h) if liso-cel or ida-cel

Grade 2

    • Tocilizumab
    • Dexamethasone 10 mg q12-24 h if hypotension resistant to 1-2 doses of tocilizumab

Grade 3

    • Tocilizumab
    • Dexamethasone 10 mg q6-12 h

Grade 4

    • Tocilizumab
    • Dexamethasone 10 mg q6 h or methylprednisolone 1-2g/d x 3 doses
    • Anakinra if refractory to anti-IL6 therapy and high dose steroid

Management of CAR T-cell Induced Cytokine Release Syndrome (CRS)

Grade 1

    • Monitor for progression
    • Consider tocilizumab if concurrent CRS
    • Sz prophylaxis

Grade 2

    • Dexamethasone 10 mg x 1, repeat q6-12 h if no improvement
    • Sz prophylaxis

Grade 3

    • Dexamethasone 10 mg q6 h or methylprednisolone 1 mg/kg q12 h
    • Anakinra 100mg q6h if not responsive to steroids
    • Sz prophylaxis

Grade 4

    • Methylprednisolone 1-2 g/d x 3 days then rapid taper
    • Consider Anakinra 100 mg q6h if not responsive to steroids
    • Sz prophylaxis

Management of CAR T-cell Induced Immune Effector Cell Associated Neurotoxicity (ICANS)

NCCN Guidelines: Management of Immunotherapy Related Toxicity. V1.2025

See individual CAR T-cell agent prescribing information for agent specific CRS/ICANS management toxicity.

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Tocilizumab Prophylaxis Update

  • Teclistamab

​

  • Teclistamab, elranatamab, talquetamab, n=72
    • Toci prior to 1st step up dose

​

​

​

​

No Toci n=48

Toci 8 mg/kg 4 h prior to 2nd step up dose

n=33

CRS

73%

30%

ICANS

20%

6%

Readmissions w/in 14 d

0%

20%

Toci 8 mg/kg 4 h prior to 1st step up dose

n=31

CRS

13%

ICANS

10%

Blood. 2023;142(S1):2008

Blood 2023;142(S1):4709

​

All Patients

Teclistamab

N=36

Elranatamab

N=20

Talquetamab

N=16

CRS

14%

11%

20%

13%

ICANS

8%

8%

0%

19%

Blood. 2024;144(S1):932

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Siltuximab: Potential Alternative to Tocilizumab?

IL-6 binding monoclonal antibody

Slightly different mechanism than tocilizumab

No paradoxical increase in circulating IL-6 levels

Phase 2 study:

CAR T-Cell therapy with resistant Grade 1 CRS /ICANS ≥ 12 hrs. or Grade ≥ 2 CRS/ICANS

N=20

Siltuximab 11 mg/kg

One repeat dose given if persisted ≥ 12 hours

CRS

N=9

CRS/ICANS

N=10

ICANS

N=1

CRS efficacy (n=19)

    • 15/19 patients had resolution
    • 12 patients required 2 doses
    • Tocilizumab given to 4 patients
    • Siltuximab CR rate: 79%

ICANS efficacy (n=11)

    • 5/11 patients had resolution
    • 12 patients required 2 doses
    • Steroids used in all patients, anakinra in 3
    • Siltuximab CR rate: 45%

Blood. 2024;144(S1):3449

Axi-cel, n=52, 81% with CRS (10% G3/4), 65% with ICANS (31% G3/4)

Toci refractory: 15%; Steroid refractory: 33%

Improved CRS grade, all patients (toci refractory)

86% (50%)

Time to CRS resolution

1.5 d

Improved ICANS grade, all patients (steroid refractory)

68% (76%)

Time to ICANS resolution

5d

Blood. 2023;142(S1):4502

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CAR T-cell Immune Effector Cell Associated Hemophagocytic Lymphohistiocytosis Like Syndrome (IEC-HS)

  • Development of pathologic and biochemical hyperinflammation syndrome independent from CRS and ICANS
    • Manifests with features of macrophage activation/HLH

​

​

​

​

​

​

​

  • New onset cytopenia, hyperferritinemia (>2 x ULN), coagulopathy with hypofibrinogenemia, and/or transaminitis

​

​

​

1st Line Therapy:

Anakinra ± steroids

2nd Line Therapy:

Add ruxolitinib

3rd Line Therapy:

Low dose etoposide, emapalumab

Transplant Cell Ther. 2023;29(7) 438.e1–438.e16

NCCN Guidelines: Management of Immunotherapy Related Toxicity. V1.2025

​

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CAR T-cell Immune Effector Cell Associated Hematotoxicity (ICAHT)

Lancet Haematol 2024;11: e459–70

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CAR-T Associated Coagulopathy (CARAC)

  • Incidence ~ 50%
    • 20% with CARAC experience bleeding
    • 14-50% progress to DIC
  • Timing w/in 28 days
    • most w/in 6-10 days post infusion

​

  • Prolonged aPTT and PT, reduced fibrinogen, elevated D-dimer

​

  • Risk factors: CRS/ICANS, rapid CAR T-cell expansion, high baseline tumor burden, low baseline platelets

​

  • Management: Fibrinogen replacement, fresh frozen plasma, steroids, tocilizumab

​

​

​

​

“Other” Non-ICANS Neurotoxicity

  • Associated with anti-BCMA CAR T-cell therapy (Cilta-cel & Ide-cel)
  • Onset: 11 – 108 days

​

  • Movement and neurocognitive treatment-emergent AEs
    • Manifestations similar to Parkinson’s disease
    • Risk factors: high baseline tumor volume, CRS/ICANS, high CAR T-cell expansion/persistence
    • Steroids, CAR T-cell ablation

​

  • Peripheral neuropathy
    • Lower motor neuron facial paralysis, cranial nerve palsy, peripheral sensory and motor neuropathy
    • Steroids, IVIG

​

​

Experimental Hematology & Oncology. 2024;13:110

NCCN Guidelines: Management of Immunotherapy Related Toxicity. V1.2025

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Infection Risk – Bispecific Antibodies for Multiple Myeloma

  • BCMA present on plasma cells and some B-cells (GPRC5D present on plasma cells)
  • Prophylactic IVIG: 90% decrease in infection

​

  • 2023 Expert Panel Consensus Recommendations
    • Monitor Ig levels monthly
    • IVIG replacement

​

​

​

    • Acyclovir or valacyclovir prophylaxis and PJP prophylaxis
  • Other strategies: Utilize Q2week dosing (when possible)

​

Anti-BCMA

Anti-GPRC5D

Teclistamab

Elranatamab

Talquetamab Qwk

Talquetamab Q2wk

Infections All Grade

Grade 3/4

Grade 5

76.4%

44.8%

8.5%

66.7%

35.0%

6.5%

46.7%

6.7%

--

38.6%

9.1%

--

Hypogammaglobulinemia

74.5% (<500)

75.2% (<400)

87% (<500)

71% (<500)

Blood Cancer J. 2023;13:116

Blood Cancer J. 2024;14:110

​

IgG levels <400 mg/dL

≥ 2 severe recurrent infections

Life-threatening infection

Documented infection with insufficient response to antibiotics

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Management of BTCE CRS and ICANS

  • CRS
    • Prescribing information: “Treat per current practice guidelines”
      • Pretreat with next dose and consider hospitalization for next dose
      • D/C if grade 4 or recurrent grade 3
    • NCCN guidelines: Consider providing one dose of dexamethasone 8 mg to take if needed for severe CRS (shaking, chills, felling severely ill) at home prior to going to ED

​

  • ICANS
    • D/C if grade 4 or recurrent grade 3 (glofitamab: d/c if grade 3 > 7d)
    • 4 products have more prescriptive recommendations (epcoritamab, elranatamab, teclistamab, talquetamab)

​

​

Sz prophylaxis

Grade ≥ 2: dex 10 mg IV q6h until ≤ grade 1 then taper

Grade 4: consider methylprednisolone 1g/d x 3d

D/C if grade 4 or recurrent grade3

NCCN Guidelines: Management of Immunotherapy Related Toxicity. V1.2025

Derived from Prescribing Information for each medication as of 12/2024

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Conclusions

  • Therapeutic strategies to mitigate risk and manage CRS/ICANS are increasing as we gain experience with these products

​

  • Immune effector cell toxicities occur commonly and require prompt recognition and grading

​

  • Early, grade-based management with tocilizumab and/or steroids is necessary to prevent progression

​

  • Additional agents becoming standard (i.e., anakinra) in patients not responding to first line therapy with more under investigation

​

  • Additional toxicities coming to the foreground as we gain experience with immune effector cell therapies

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Understanding and Managing Immune Effector Cell �Toxicities in Hematologic Malignancies in 2025�

David Reeves, PharmD, BCOP

​

Professor of Pharmacy Practice

Butler University

​

Clinical Pharmacy Specialist – Hematology/Oncology

Franciscan Health Indianapolis

�

�