Abstract：
BACKGROUND: Chimeric antigen receptor (CAR) T cell therapy is an immunotherapy that has resulted in tremendous progress in the treatment of patients with B cell malignancies. However, significant toxicities may also be associated with such therapy. Here we report extremely high ferritin in a male patient after such therapy.
METHODS: We present a case of a 52 year old male with a history of B-cell acute lymphoblastic leukemia who received chimeric antigen receptor T-cell (CAR-T) therapy with rapcabtagene autoleucel (carvykti). The patient subsequently developed cytokine release syndrome (CRS) which during its resolution results in a hemophagocytic lymphohistiocytosis (HLH)-like syndrome that fell short of being diagnostic. This syndrome tracked closely with the onset and resolution of immune-effector cell-associated neurotoxicity syndrome (ICANS), with close correlation between the severity of laboratory abnormalities, particularly extremely high ferritin (peak value: 81,540 μg/L), and clinical encephalopathy.
CONCLUSIONS: Cytokine release syndrome after experimental (CAR) T cell therapy may cause extremely elevated ferritin and hemophagocytic lymphohistiocytosis -like syndrome.
METHODS: We present a case of a 52 year old male with a history of B-cell acute lymphoblastic leukemia who received chimeric antigen receptor T-cell (CAR-T) therapy with rapcabtagene autoleucel (carvykti). The patient subsequently developed cytokine release syndrome (CRS) which during its resolution results in a hemophagocytic lymphohistiocytosis (HLH)-like syndrome that fell short of being diagnostic. This syndrome tracked closely with the onset and resolution of immune-effector cell-associated neurotoxicity syndrome (ICANS), with close correlation between the severity of laboratory abnormalities, particularly extremely high ferritin (peak value: 81,540 μg/L), and clinical encephalopathy.
CONCLUSIONS: Cytokine release syndrome after experimental (CAR) T cell therapy may cause extremely elevated ferritin and hemophagocytic lymphohistiocytosis -like syndrome.
摘要：
背景：嵌合抗原受体（CAR）T细胞疗法是一种免疫疗法，在治疗B细胞恶性肿瘤患者方面取得了巨大进展。然而,显著的毒性也可能与这种治疗有关。在这里，我们报告了这种治疗后男性患者的铁蛋白极高。
方法：我们介绍了一例52岁男性，有B细胞急性淋巴细胞白血病病史，他接受了嵌合抗原受体T细胞（CAR-T）治疗。患者随后发展为细胞因子释放综合征（CRS），在其解决过程中导致噬血细胞性淋巴组织细胞增多症（HLH）样综合征，无法诊断。该综合征与免疫效应细胞相关神经毒性综合征（ICANS）的发病和消退密切相关，与实验室异常的严重程度密切相关，特别是极高的铁蛋白（峰值：81,540μg/L），和临床脑病。
结论：实验性（CAR）T细胞治疗后的细胞因子释放综合征可能导致铁蛋白极度升高和噬血细胞淋巴组织细胞增多样综合征。
方法：我们介绍了一例52岁男性，有B细胞急性淋巴细胞白血病病史，他接受了嵌合抗原受体T细胞（CAR-T）治疗。患者随后发展为细胞因子释放综合征（CRS），在其解决过程中导致噬血细胞性淋巴组织细胞增多症（HLH）样综合征，无法诊断。该综合征与免疫效应细胞相关神经毒性综合征（ICANS）的发病和消退密切相关，与实验室异常的严重程度密切相关，特别是极高的铁蛋白（峰值：81,540μg/L），和临床脑病。
结论：实验性（CAR）T细胞治疗后的细胞因子释放综合征可能导致铁蛋白极度升高和噬血细胞淋巴组织细胞增多样综合征。
