T cells can be genetically modified to target tumors through the expression of a chimeric antigen receptor (CAR). Most notably, CAR T cells have demonstrated clinical efficacy in hematologic malignancies with more modest responses when targeting solid tumors. However, CAR T cells also have the capacity to elicit expected and unexpected toxicities including: cytokine release syndrome, neurologic toxicity, "on target/off tumor" recognition, and anaphylaxis. Theoretical toxicities including clonal expansion secondary to insertional oncogenesis, graft versus host disease, and off-target antigen recognition have not been clinically evident. Abrogating toxicity has become a critical step in the successful application of this emerging technology. To this end, we review the reported and theoretical toxicities of CAR T cells and their management.

中文翻译：

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CAR T 细胞疗法的毒性和管理。

T 细胞可以通过表达嵌合抗原受体 (CAR) 进行基因改造以靶向肿瘤。最值得注意的是，CAR T 细胞在血液系统恶性肿瘤中表现出临床疗效，在靶向实体瘤时反应更温和。然而，CAR T 细胞也有能力引发预期和意外的毒性，包括：细胞因子释放综合征、神经毒性、“靶向/脱瘤”识别和过敏反应。理论上的毒性，包括继发于插入性肿瘤发生、移植物抗宿主病和脱靶抗原识别的克隆扩增，在临床上并不明显。消除毒性已成为成功应用这一新兴技术的关键一步。为此，我们回顾了 CAR T 细胞的报道和理论毒性及其管理。