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CAR-T Cell Therapy: Anti-CD19 and Anti-BCMA Approaches

Engineered T cells in B-cell malignancies and multiple myeloma

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is CAR-T Cell Therapy: Anti-CD19 and Anti-BCMA Approaches?

CAR-T cells are autologous T lymphocytes collected by leukapheresis and engineered ex vivo with a chimeric antigen receptor.

The receptor combines an extracellular antibody-derived single-chain variable fragment with intracellular CD3 zeta and costimulatory domains (CD28 or 4-1BB).

Anti-CD19 products (tisagenlecleucel, axicabtagene ciloleucel, brexucabtagene autoleucel, lisocabtagene maraleucel) target CD19 on B-cell malignancies.

Anti-BCMA products (idecabtagene vicleucel, ciltacabtagene autoleucel) target B-cell maturation antigen on multiple myeloma plasma cells.

Lymphodepleting chemotherapy with fludarabine and cyclophosphamide precedes infusion to support CAR-T expansion and persistence.

Symptoms

Cytokine release syndrome (CRS) presents with fever, hypotension, hypoxia and tachycardia, usually within the first week.
Immune effector cell-associated neurotoxicity syndrome (ICANS) causes confusion, dysphasia, tremor, seizures and rarely cerebral edema.
Hematologic toxicities include prolonged cytopenias and increased infection risk.
Hypogammaglobulinemia from B-cell aplasia leads to recurrent infections requiring immunoglobulin replacement.
Tumor lysis syndrome, macrophage activation syndrome and rare second malignancies are also reported.

Risk Factors

High disease burden, elevated LDH, ferritin, CRP and inflammatory markers correlate with severe CRS and ICANS.
Older age, neurologic comorbidities and prior CNS disease increase neurotoxicity risk.
Cardiopulmonary disease and renal dysfunction limit tolerance to fluid resuscitation and tocilizumab support.
Active uncontrolled infection or severe organ dysfunction precludes treatment.
Logistic factors including time from apheresis to infusion and bridging therapy quality affect outcomes.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • High fever, low blood pressure, low oxygen saturation, severe fatigue or rapid heart rate after infusion suggest CRS.
  • Confusion, slowed speech, tremor, seizures, hand-eye coordination problems or unresponsiveness raise concern for ICANS.
  • Severe bleeding, bruising or persistent infection warrant urgent hematologic evaluation.
  • Recurrent fevers, persistent diarrhea, productive cough or severe abdominal pain may signal opportunistic infection.
  • Loss of consciousness, severe headache, focal neurological deficits or chest pain demand immediate emergency care.

Treatment Methods

01
CRS grade 1 is managed with supportive care; grade 2 with tocilizumab; grade 3-4 with tocilizumab and corticosteroids in intensive care setting.
02
ICANS is treated with corticosteroids, supportive seizure prophylaxis, and intensive monitoring; tocilizumab is used cautiously due to limited CNS penetration.
03
Anakinra and other IL-1 antagonists are emerging for steroid-refractory CRS or hemophagocytic-like syndromes.
04
Hypogammaglobulinemia is managed with intravenous immunoglobulin replacement and antimicrobial prophylaxis.
05
Long-term follow-up includes monitoring for relapse, late cytopenias, second malignancies and quality of life recovery.

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.