What management is recommended for a patient with a sore throat and difficulty swallowing at day+15 post-retreatment with MT-601 (investigational immune effector cellular product) without lymphodepletion?

Management of Sore Throat in Patient Post-Immune Effector Cell Therapy

For a patient at day+15 post-retreatment with MT-601 (investigational immune effector cellular product) presenting with sore throat and difficulty swallowing, ibuprofen or paracetamol should be recommended as first-line treatment for symptom relief. 1, 2

Initial Assessment

When evaluating this patient's sore throat symptoms, consider:

• Timing: Day+15 post-retreatment with investigational immune effector cellular therapy
• Symptoms: Sore throat and difficulty swallowing
• No other signs of cytokine release syndrome (CRS)
• No lymphodepletion during retreatment

Recommended Management

First-line Treatment

• Analgesics:

  • Ibuprofen (preferred) or paracetamol for pain relief 1, 2
  • Dosing: Regular ibuprofen 400mg every 6-8 hours as needed (not exceeding 2400mg/day)
  • Alternative: Paracetamol 1000mg every 6 hours as needed (not exceeding 4000mg/day)

• Topical Relief Options:

  • Flurbiprofen 8.75mg lozenges every 3-6 hours as needed (up to 5 lozenges in 24 hours) 3
  • This can provide targeted relief for swollen and inflamed throat symptoms

Hydration and Supportive Care

• Encourage adequate fluid intake
• Warm salt water gargles (1/2 teaspoon salt in 8oz warm water)
• Avoid irritants such as smoking, alcohol, and spicy foods

Important Considerations for This Patient

1. Monitor for CRS progression: Although the patient currently shows no other signs of CRS, sore throat could potentially be an early symptom. The patient should be instructed to contact the healthcare team immediately if they develop:

   • Fever
   • Shortness of breath
   • Hypotension
   • Worsening symptoms

2. Avoid corticosteroids: While corticosteroids can be considered for severe sore throat in general populations 1, they should be avoided in this patient as they might interfere with the immune effector cell therapy.

3. Avoid unnecessary antibiotics: Without evidence of bacterial infection (such as 3-4 Centor criteria), antibiotics should not be prescribed 1, 2.

4. Not recommended:

   • Zinc gluconate (inconsistent evidence and more adverse effects) 1, 2
   • Herbal treatments or acupuncture (inconsistent evidence) 1

Follow-up Recommendations

• If symptoms worsen before the next scheduled appointment, the patient should seek immediate medical attention
• If difficulty swallowing progresses to inability to maintain adequate hydration, earlier evaluation is warranted
• At next week's appointment, reassess symptoms and evaluate for any signs of:
  • Bacterial infection
  • CRS development
  • Other complications related to the immune effector cell therapy

This approach provides effective symptom relief while ensuring appropriate monitoring for this patient with a unique clinical context of recent investigational immune effector cell therapy.