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Axicabtagene ciloleucel // Yescarta

CAR-T ( Chimeric antigen receptor -T cell therapy)

MECHANISM OF ACTION

YESCARTA, a CD19-directed genetically modified autologous T cell immunotherapy, binds to CD19-expressing cancer cells and normal B cells. Studies demonstrated that following anti-CD19 CAR T cell engagement with CD19-expressing target cells, the CD28 and CD3-zeta co-stimulatory domains activate downstream signaling cascades that lead to T cell activation, proliferation, acquisition of effector functions and secretion of inflammatory cytokines
and chemokines. This sequence of events leads to killing of CD19-expressing cells.

Route of elimination: none known

MECHANISM OF KIDNEY INJURY

in patients with CRS, decrease perfusion vs ATN

CLINICAL KIDNEY SYNDROME

AKI, CRS

CARDIOVASCULAR ADVERSE EFFECTS

Cytokine Release Syndrome, Capillary leak, arrhythmia, VTE

LYTE ABNORMALITIES

Hypocalcemia, Hypokalemia, Hypophosphatemia, Hyponatremia, Hypomagnesemia, Hypoalbuminemia

RISK FACTORS

MITIGATION STRATEGIES

if CRS - tocilizumab

SUGGESTIONS 

if CRS tocilizumab

NOTES/COMMENTS

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PHARMACOKINETICS

Molecular Weight

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Volume of Distribution

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Plasma Protein Binding

Metabolism

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Bioavailability

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Half-life elimination

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Time to peak

Maximal expansion in peripheral blood is 7-14 days after infusion

Excretion

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Dialyzable?

Unknown

REF:

PATHOLOGY SLIDES:

ENTRY UPDATES:

Marco Bonilla

Chicago/USA

Sep 25, 2022

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