Identifying and managing CAR T-cell-mediated toxicities: on behalf of an Italian CAR-T multidisciplinary team

INTRODUCTION

Chimeric antigen receptor (CAR)-T-cell therapy is a new treatment for patients with hematologic malignancies in which other therapies have failed.

AREAS COVERED

The review provides an overview for recognizing and managing the most acute toxicities related to CAR-T cells.

EXPERT OPINION

The development of immune-mediated toxicities is a common challenge of CAR-T therapy. The mechanism that determines this toxicity is still unclear, although an unfavorable tumor microenvironment and a pro-inflammatory state put patients at risk. The monitoring, diagnosis, and treatment of post-CAR-T toxicities must be determined and based on international guidelines and internal clinical practice. It is urgent to identify biomarkers that can identify patients at greater risk of developing complications. The adoption of consistent grading criteria is necessary to improve toxicity management strategies continually. The first-line therapy consists of supportive care and treatment with tocilizumab or corticosteroids. An early start of cytokine blockade therapies could mitigate toxicity. The plan will include cytokine release prophylaxis, a risk-adapted treatment, prevention of on-target/off-tumor effect, and a switch on/off CAR-T approach.

Evaluation of factors affecting total nucleated cells in umbilical cord blood collected for the Calabria cord blood bank

BACKGROUND

Total nucleated cell (TNC) count is the most important biological feature to consider in assessing the quality of umbilical cord blood (UCB) for haematopoietic stem cell (HSC) transplantation. Certain obstetric factors have been reported to increase TNC count in UCB units collected for transplantation. The aim of our study was to analyze how various maternal, neonatal and obstetric factors affected TNC count in the UCBs we collected for our cord blood bank in southern Italy.

MATERIAL AND METHODS

We performed a retrospective analysis of 634 medical records of UCBs collected by Calabria Cord Blood Bank (CCBB), between January 1, 2010 and December 31, 2016. We analyzed various maternal, neonatal and obstetric variables factors and related this factor with the characteristic of TNC.

RESULTS

We found that the average number of TNCs was significantly greater in vaginal delivery than in caesarean delivery. We also found that TNCs were higher in the 40th week of pregnancy and when Apgar 1' scores were ≤ 9. The effect of a newborn's gender was less evident on TNC count.

CONCLUSIONS

Knowledge of factors predictive of a higher TNC count would help cord blood banks more efficiently identify donors likely to yield high-quality UCBs for transplantation.

[Clinico-statistical studies of the tibial varism frequent among the school population of the Chiavenna valley and its relation to varus arthropathy of the knee in adults]

384 adolescents in Chiavenna schools were examined in a study of the considerable incidence of tibia vara, seen as a first step towards the patterns of varizing arthrosic deformation of the knee in adults of the same zone; at the same time indications on prophylactic-preventive measures in the field of scholastic and sport medicine were given.

[Method of construction of the EDF plaster-of-paris corset for correction of progressive scoliosis]

Some technical details are given with regard to making up the E.D.F. corrective corset used by the authors, who have wide experience in the bloodless treatment of infantile and youthful evolutive scoliosis, with a view to a wider spread of prophylaxis and treatment appliances by the Higher Health Boards today in operation.