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High Dose Versus Low Dose CART-19 Therapy in CLL

High Dose Versus Low Dose CART-19 Therapy in CLL
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Published on June 25, 2020

High Dose Versus Low Dose CART-19 Therapy in CLL

Patients with advanced chronic lymphocytic leukemia (CLL) may be eligible to receive a higher dose of a chimeric antigen receptor (CAR) T-cell therapy, but is it safe?

A recent small study showed that in patients with advanced or relapsed CLL, a higher dose of CART-19 may be more effective than a lower dose at inducing a complete response without excessive toxicity.1

CART-19 was created to attack the CD19 antigen, a biomarker on the surface of B cells that is used to diagnose cancers arising from this type of cell. The name CD19 should not be confused with COVID-19, which was assigned that number because of the year it was discovered, 2019.

Attaining a complete response after CART-19 infusion, regardless of cell dose, is associated with longer overall survival and progression-free survival in patients with relapsed CLL.

Side Effects Can Include Cytokine Storm

Some patients experience serious side effects from CART-19 therapy, especially as the CAR-T cells multiply in the body to fight the cancer. As CAR-T cells multiply, they cause massive amounts of chemicals called cytokines to be released into the blood. Concerning side effects of this release can include high fevers and dangerously low blood pressure in the days after treatment is administered. This is called cytokine release syndrome, or cytokine storm. Imagine July 4th fireworks going off inside your immune system. Even though it can be a scary side effect, it means the CAR-T cells are working. Oncologists expect the cytokine storm and are prepared to treat it.

Is Age a Factor in CAR T-Cell Therapy?

“Age does certainly come up as a question,” said Dr. Danielle Brander, a CLL expert from Duke Cancer Institute, in a recent Patient Power interview. “If it’s for a given trial, a given trial might have to determine a cut-off from a safety perspective. But, in general, I’d say one shouldn’t assume that there’s an absolute age cut-off as much as patient function. Function is a very important part of considering whether patients can safely go through the treatment. And that’s really kind of a one-on-one discussion.”

To learn more from Dr. Brander, watch or read the transcript for CAR T: Is Age a Factor?

If you are considering CAR T-cell therapy, consult a specialist for help. Having CLL doesn’t have to stop you from doing your normal activities, even exercising, but remember to give yourself extra time to rest and recuperate from activities and infusion days.

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~Lauren Evoy Davis

1Frey NV, et al. Long-Term Outcomes From a Randomized Dose Optimization Study of Chimeric Antigen Receptor Modified T Cells in Relapsed Chronic Lymphocytic Leukemia. J Clin Oncol. April 16, 2020.

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