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:
https://pubmed.ncbi.nlm.nih.gov/34895487/
https://academic.oup.com/oncolo/article/25/10/894/6443744?login=true
https://pubmed.ncbi.nlm.nih.gov/30518502/
PATHOLOGY SLIDES:
ENTRY UPDATES:
Marco Bonilla
Chicago/USA
Sep 25, 2022