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Editorials
ence in CAR-T cell treatment, the earlier any side effects will be recognized and appropriately treated, therefore, becoming less severe; third, it is likely that side effects are less severe in different upcoming entities such as multiple myeloma making the allogeneic transplant expert less important. However, currently the most beneficial approach would be the joint effort of both, i.e. of myelo- ma and CAR-T-cell specialists, the latter often coming from allogeneic teams like ours (or being combined in an allogeneic and myeloma expert in one person), which is already pursued in many centers worldwide.18
In summary, while it may be good thinking to start with the best available team including the allogeneic transplant expert, once the treatment procedure becomes established, the specialized hematologist will presumably take over the leading role in guiding and performing the application of CAR-T cells, including the treatment of any potentially evolving complications.
References
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3. Maude SL, Laetsch TW, Buechner J, et al. Tisagenlecleucel in Children and Young Adults with B-Cell Lymphoblastic Leukemia. N Engl J Med. 2018;378(5):439-448.
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Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biol Blood Marrow Transplant. 2019;25(4):625-638.
14. Shah NN, Fry TJ. Mechanisms of resistance to CAR T cell therapy. Nat Rev Clin Oncol. 2019;16(6):372-385.
15. Abboud R, Keller J, Slade M, et al. Severe Cytokine-Release Syndrome after T Cell-Replete Peripheral Blood Haploidentical Donor Transplantation Is Associated with Poor Survival and Anti-IL- 6 Therapy Is Safe and Well Tolerated. Biol Blood Marrow Transplant. 2016;22(10):1851-1860.
16. Raj RV, Hamadani M, Szabo A, et al. Peripheral Blood Grafts for T Cell-Replete Haploidentical Transplantation Increase the Incidence and Severity of Cytokine Release Syndrome. Biol Blood Marrow Transplant. 2018;24(8):1664-1670.
17. Moreau P, Sonneveld P, Boccadoro M, et al. Chimeric antigen recep- tor T-cell therapy for multiple myeloma: a consensus statement from The European Myeloma Network. Haematologica. 2019;104(12): 2358-2360.
18. Greil C, Engelhardt M, Ihorst G, et al. Allogeneic transplantation of multiple myeloma patients may allow long-term survival in carefully selected patients with acceptable toxicity and preserved quality of life. Haematologica. 2019;104(2):370-379.
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