Future study of late effects following CAR T-cells
| . | Recommendations . |
|---|---|
| Long-term monitoring guidelines | At present guidelines specific to CAR T-cell long-term follow-up do not exist. Recommend use of existing guidelines for post HCT (if indicated) or completion of therapy follow-up for specific end-organ monitoring (eg, endocrinopathies, neurocognitive function, cardiac) as related to impact of therapy a patient may have received prior to CAR T-cells. Continue monitoring for B-cell aplasia, hypogammaglobulinemia, and responses to vaccination. |
| CAR T-cell–associated mutagenesis | To date, CAR T-cell–induced malignancies have not been seen with use of standard approaches to transduction and manufacturing approaches. Continue ongoing monitoring as novel strategies are implemented. |
| Second malignant neoplasms | Risk is likely not higher with use of CAR T-cells above and beyond what would be anticipated in patients with comparable lines of prior therapy. Close monitoring will be needed as patients receive fewer lines of therapy and get CAR T-cells earlier in the treatment paradigm. |
| Fertility | The impact of CAR T-cells on fertility is unknown. Systematic studies of patients who go on to father a child/become pregnant and have a live birth are needed. Improved strategies for implementing fertility discussion in the peri CAR T-cell setting are needed (beyond those advising on avoiding pregnancy in the immediate CAR T-cell infusion period). |
| . | Recommendations . |
|---|---|
| Long-term monitoring guidelines | At present guidelines specific to CAR T-cell long-term follow-up do not exist. Recommend use of existing guidelines for post HCT (if indicated) or completion of therapy follow-up for specific end-organ monitoring (eg, endocrinopathies, neurocognitive function, cardiac) as related to impact of therapy a patient may have received prior to CAR T-cells. Continue monitoring for B-cell aplasia, hypogammaglobulinemia, and responses to vaccination. |
| CAR T-cell–associated mutagenesis | To date, CAR T-cell–induced malignancies have not been seen with use of standard approaches to transduction and manufacturing approaches. Continue ongoing monitoring as novel strategies are implemented. |
| Second malignant neoplasms | Risk is likely not higher with use of CAR T-cells above and beyond what would be anticipated in patients with comparable lines of prior therapy. Close monitoring will be needed as patients receive fewer lines of therapy and get CAR T-cells earlier in the treatment paradigm. |
| Fertility | The impact of CAR T-cells on fertility is unknown. Systematic studies of patients who go on to father a child/become pregnant and have a live birth are needed. Improved strategies for implementing fertility discussion in the peri CAR T-cell setting are needed (beyond those advising on avoiding pregnancy in the immediate CAR T-cell infusion period). |
HCT, hematopoietic cell transplant.