Abstract
Purpose :
T cells can be genetically engineered to express anti-CD19 chimeric antigen receptors (CAR). CAR T-cells have demonstrated efficacy in patients with refractory hematologic malignancies after failure of conventional therapy. While investigators at the National Cancer Institute have found high rates of remission beyond 4 years, suggesting this therapy as potentially curative, there have been documented toxicities which can be lethal if not recognized in a timely manner. CAR T-cells can elicit unexpected toxicities including cytokine release syndrome, neurologic toxicity, graft versus host disease, and tumor lysis syndrome. Papilledema has been a cited ocular finding in patients with cytokine release syndrome and CAR T-cell related encephalopathy. The purpose of this study is to assess and report ocular toxicities of CAR-T cell therapy as it has not yet been described in the literature.
Methods :
This is a retrospective chart review of all patients, aged 18 years or older who received standard of care CAR-T Therapy for a hematologic malignancy with an ophthalmic evaluation during their treatment at a tertiary care center from February 2018 to October 2019. 54 patients recieved CAR-T cell infusion. A total of 11 patients met the inclusion criteria and were included in the chart review. Patient symptoms, and clinician ophthalmic examination findings were documented.
Results :
11 patients treated with CAR T-cell therapy, and with an ophthalmic examination were identified in the study. Seven patients had subjective symptoms prompting ophthalmic examination. Three patients reported subjective blurry vision however no ophthalmic exam findings were found. One case of worsening chronic ocular GVHD was found in a patient who developed persistent epithelial defects and worsening symblepharon after CAR T infusion. Two patients were identified with possible reactivation of varicella zoster virus, including Herpes Zoster Ophthalmicus and regressing Acute Retinal Necrosis. Notably, none of the patients in our study were noted to have papilledema, a frequent reason for ophthalmic consultation when there is concern for neurological toxicity.
Conclusions :
CAR T-cell therapy has led to improved remission rates among patients with hematologic malignancies. The increasing use of CAR therapy means clinicians should understand potential toxicities including ocular toxicities that are present and when to refer for an ophthalmic examination.
This is a 2020 ARVO Annual Meeting abstract.