背景:细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS)是与嵌合抗原受体(CAR)T细胞治疗相关的常见毒性。严重的3级或更高的ICANS不太常见,需要在有或没有白细胞介素(IL)-6受体拮抗剂的情况下使用皮质类固醇。尽管皮质类固醇在CRS和ICANS的管理中有效,它们对CAR-T疗效的影响尚不清楚.
方法:我们介绍了一例65岁的男性,他接受了CAR-T细胞疗法联合brexucabtageneautoleucel治疗I/II期套细胞淋巴瘤(MCL),尽管接受了治疗严重ICANS的糖皮质激素疗程延长,但仍获得完全缓解。
方法:患者接受大剂量皮质类固醇治疗,托珠单抗,还有Anakinra,除了多种抗癫痫药。尽管ICANS的复发模式有所缓解,患者不仅从危及生命的并发症中康复,而且在CART后3个月实现完全缓解。
结论:本病例描述了在1例MCL接受CART细胞治疗的患者中,成功使用皮质类固醇治疗ICANS.
BACKGROUND: Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are common toxicities associated with chimeric antigen receptor (CAR) T-cell therapy. Severe grade 3 or higher ICANS is less common and requires the use of corticosteroids with or without an Interleukin (IL)-6 receptor antagonist. Although corticosteroids are effective in the management of CRS and ICANS, their impact on CAR T efficacy remains unknown.
METHODS: We present the case of a 65-year-old male who received CAR T-cell therapy with brexucabtagene autoleucel for stage I/II Mantle Cell Lymphoma (MCL) and achieved complete remission despite receiving a prolonged course of corticosteroids for severe ICANS.
METHODS: The patient received treatment with high-dose corticosteroids, tocilizumab, and anakinra, in addition to multiple antiepileptic agents. Despite a remitting relapsing pattern of ICANS, the patient not only recovered from the life-threatening complication but also achieved a complete remission at three months post CAR T.
CONCLUSIONS: This case describes the successful use of corticosteroids for the management of ICANS in a patient treated with CAR T-cell therapy for MCL.