ICE-T Conference Highlights Critical Need for Standardized CAR T-Cell Therapy Supportive Care Protocols
核心洞察
Experts at the 2025 National ICE-T Conference revealed significant institutional variability in prophylactic levetiracetam use for preventing seizures in CAR T-cell therapy patients, with some centers using it routinely while others only initiate treatment after ICANS occurs.
The conference emphasized the urgent need for improved access to newer CAR T-cell therapies targeting CD20 (搜索) and CD22 (搜索) antigens beyond current CD19 (搜索)-targeting treatments, particularly for acute lymphoblastic leukemia (搜索) patients.
Neurological toxicities, including immune effector cell-associated neurotoxicity syndrome (搜索) (ICANS) and parkinsonism (搜索), remain major challenges requiring better diagnostic and management protocols across treatment centers.
The 2025 National Immune Cell Effector Therapy (ICE-T) Conference brought together leading experts to address critical gaps in CAR T-cell therapy supportive care, revealing significant institutional variations in toxicity management protocols and highlighting the urgent need for expanded therapeutic options.
Institutional Variability in Seizure Prevention Protocols
A key discussion point centered on the heterogeneous use of prophylactic levetiracetam (Keppra) across treatment centers. According to Nausheen Ahmed, MD, associate professor and associate director for Cellular Therapeutics at the University of Kansas Cancer Center (搜索), "There are some institutions that use it across the board from day 0 to day 30, and then there are some institutions that don't. They will only initiate it if there is an event of ICANS."
This variability reflects a critical knowledge gap in the field. "We need a study or retrospective data to look at that, but right now, we don't have any hard data to do the prophylaxis. However, we don't have any data on what happens when we don't use it," Ahmed explained during the conference.
Neurological Toxicity Management Challenges
The conference's Supportive Care in Leukemia Session featured comprehensive discussions on immune effector cell-associated neurotoxicity syndrome (搜索) (ICANS) management. Muhammad M. Nashatizadeh, MD, a neurologist participating in the session, outlined the complex diagnostic challenges clinicians face when differentiating ICANS from other neurological conditions.
The session covered differential diagnoses including encephalopathies, toxic encephalopathies, drug interactions, and delirium. Particular attention was given to managing parkinsonism (搜索) associated with specific CAR T-cell therapies, such as ciltacabtagene autoleucel (Carvykti) in multiple myeloma (搜索) treatment.
Expanding Therapeutic Options Beyond CD19
Current CAR T-cell therapies primarily target CD19 (搜索), but experts emphasized the critical need for broader targeting capabilities. Ahmed highlighted promising developments in multi-target approaches: "Sunil Abhyankar, MD, brought up his triple-threat CAR T-cell therapy, which targets CD19, CD20 (搜索), and CD22 (搜索). It's in the context of a clinical trial, but we're eager to look at the outcomes from that."
This expansion is particularly crucial for acute lymphoblastic leukemia (搜索) (ALL) treatment, where current therapeutic limitations have created significant unmet medical needs.
Addressing Access and Implementation Barriers
The conference emphasized that toxicity management extends beyond academic medical centers. Ahmed noted that general oncologists need better understanding of CAR T-cell therapy-related complications to improve patient care across diverse healthcare settings.
"One of my key things is how we improve access, and how we improve toxicities and get this across more centers," Ahmed stated. The ICE-T symposium specifically aims to bridge academic knowledge with community practice, bringing together academic and community leaders to expand therapy access while maintaining safety standards.
Multidisciplinary Approach to Complex Cases
The session featured contributions from infectious disease specialist Aneela Majeed, MD, highlighting the importance of multidisciplinary collaboration in managing complex CAR T-cell therapy cases. This approach addresses the intersection of infectious complications and neurological toxicities that can complicate patient management.
The conference underscored that successful CAR T-cell therapy implementation requires coordinated expertise across multiple specialties, from neurology and infectious disease to hematology-oncology, to ensure optimal patient outcomes while managing the complex toxicity profiles of these advanced therapies.