Chimeric antigen receptor T-cell therapy in adults: management of toxicities and implications for critical care

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Chimeric antigen receptor (CAR) T-cell therapy is potentially life-changing in patients with haematological malignancies refractory to multiple lines of chemoimmunotherapy and stem cell transplantation. This adoptive cell immunotherapy involves harvesting and engineering patients' own T lymphocytes to express specific antitumour CARs, thereby directing them to target tumour cells. The CAR also has an intracellular, co-stimulatory domain causing in vivo CAR T-cell expansion and persistence. Chimeric antigen receptor T-cells destroy cancer cells but may also induce life-threatening, reversible toxicities that may require support from the critical care team.