Imaging the Side Effects of CAR T Cell Therapy: A Primer for the Practicing Radiologist

Sophia Huang; Dorine de Jong; Jeeban P Das; Reginald Scott Widemon; Brian Braumuller; Jacienta Paily; Aileen Deng; Connie Liou; Tina Roa; Alice Huang; Hong Ma; Belinda D'Souza; Jay Leb; Jade L'Hereaux; Pamela Nguyen; Lyndon Luk; Mark Francescone; Randy Yeh; Valerie Maccarrone; Laurent Dercle; Mary M Salvatore; Kathleen M Capaccione

doi:10.1016/j.acra.2023.04.004

Imaging the Side Effects of CAR T Cell Therapy: A Primer for the Practicing Radiologist

Acad Radiol. 2023 Nov;30(11):2712-2727. doi: 10.1016/j.acra.2023.04.004. Epub 2023 Jun 30.

Authors

Sophia Huang¹, Dorine de Jong², Jeeban P Das³, Reginald Scott Widemon¹, Brian Braumuller¹, Jacienta Paily¹, Aileen Deng⁴, Connie Liou¹, Tina Roa¹, Alice Huang¹, Hong Ma¹, Belinda D'Souza¹, Jay Leb¹, Jade L'Hereaux¹, Pamela Nguyen¹, Lyndon Luk¹, Mark Francescone¹, Randy Yeh³, Valerie Maccarrone¹, Laurent Dercle¹, Mary M Salvatore¹, Kathleen M Capaccione⁵

Affiliations

¹ Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.).
² Department of Immunology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (D.J.).
³ Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (J.D., R.Y.).
⁴ Department of Hematology and Oncology, Novant Health, 170 Medical Park Road, Mooresville, North Carolina 28117 (A.D.).
⁵ Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, New York 10032 (S.H., R.S.W., B.B., J.P., C.L., T.R., A.H., H.M., B.D.S., J.L., J.L.H., P.N., L.L., M.F., V.M., L.D., M.S., K.M.C.). Electronic address: kmc2113@cumc.columbia.edu.

PMID: 37394411
DOI: 10.1016/j.acra.2023.04.004

Abstract

Chimeric antigen receptor (CAR) T cell therapy is a revolutionary form of immunotherapy that has proven to be efficacious in the treatment of many hematologic cancers. CARs are modified T lymphocytes that express an artificial receptor specific to a tumor-associated antigen. These engineered cells are then reintroduced to upregulate the host immune responses and eradicate malignant cells. While the use of CAR T cell therapy is rapidly expanding, little is known about how common side effects such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) present radiographically. Here we provide a comprehensive review of how side effects present in different organ systems and how they can be optimally imaged. Early and accurate recognition of the radiographic presentation of these side effects is critical to the practicing radiologist and their patients so that these side effects can be promptly identified and treated.

Keywords: CAR T cell therapy; adverse events; imaging; immunology.

Publication types

Review