Targeted Anti-CD19 CAR T-Cell Therapy for Relapsed Pediatric Acute Lymphoblastic Leukemia: Managing Cytokine Release and Inpatient Protocols

Chimeric antigen receptor (CAR) T-cell therapy represents a transformative treatment for children with relapsed or refractory B-cell acute lymphoblastic leukemia (B-ALL).\n\nHere we review institutional protocols implemented at Sacred Heart across 64 pediatric infusions, evaluating early intervention with tocilizumab and dexamethasone. Implementation of automated telemetry monitoring and resident-driven grading protocols reduced ICU escalation for severe Grade 3/4 CRS from 24% to 9.4% while maintaining 12-month minimal residual disease-negative remission rates of 87.5%.