PDF(Pubmed)
Abstract：
Corticosteroid therapy is the mainstay of immune effector cell-associated neurotoxicity syndrome (ICANS) management, although its use has been associated with worse overall survival (OS) and progression-free survival (PFS) after chimeric antigen receptor T-cell (CAR-T cell) therapy. Many options are being investigated for prophylaxis and management. Accumulating evidence supports the use of intrathecal (IT) chemotherapy for the management of high-grade ICANS. Here, we describe a case of a patient with stage IV Primary mediastinal B-cell lymphoma (PMBCL) successfully treated with IT methotrexate, cytarabine, and dexamethasone as first-line therapy for CD19 CAR-T cell-associated grade IV ICANS. The stable and rapid resolution of ICANS to grade 0 allowed us to discontinue systemic corticosteroid use, avoiding CAR-T cells ablation and ensuring preservation of CAR-T cell function. The described patient achieved a complete radiologic and clinical response to CD19 CAR-T cell therapy and remains disease-free after 9 months. This case demonstrates a promising example of how IT chemotherapy could be used as first-line treatment for the management of high-grade ICANS.
摘要：
皮质类固醇治疗是免疫效应细胞相关神经毒性综合征（ICANS）管理的支柱，尽管其使用与嵌合抗原受体T细胞（CAR-T细胞）治疗后总生存期（OS）和无进展生存期（PFS）较差相关。正在研究预防和管理的许多选择。越来越多的证据支持使用鞘内（IT）化疗来管理高级ICANS。这里,我们描述了一个患者IV期原发性纵隔B细胞淋巴瘤（PMBCL）成功治疗IT甲氨蝶呤，阿糖胞苷,和地塞米松作为CD19CAR-T细胞相关IV级ICANS的一线治疗。ICANS稳定快速地解决0级，使我们能够停止全身使用皮质类固醇，避免CAR-T细胞消融并确保CAR-T细胞功能的保存。所描述的患者对CD19CAR-T细胞疗法实现了完全的放射学和临床反应，并且在9个月后保持无病。此案例证明了IT化学疗法如何用作高级ICANS管理的一线治疗的一个有希望的例子。
