背景:细胞因子释放综合征(CRS)是嵌合抗原受体T(CAR-T)细胞治疗的常见不良事件。CRS通常是一种全身性炎症反应,但在极少数情况下,它可以发生在特定的身体区域,被称为“本地CRS(L-CRS)”。“据报道,由于缺乏对托珠单抗(TCZ)和地塞米松(DEX)的反应而需要气管插管的L-CRS引起的喉头水肿。
方法:一名67岁女性复发性转化滤泡性淋巴瘤患者接受CAR-T细胞治疗。尽管她已经获得了CRS的TCZ和DEX,输液后第4天出现颈部肿胀。
方法:喉镜检查显示严重的喉头水肿,这被认为是由于L-CRS,因为没有其他基于历史的明显触发因素,体检,和计算机断层扫描。
方法:由于存在上呼吸道阻塞的风险而进行气管插管。最终,需要4剂量的托珠单抗(8mg/kg)和6剂量的地塞米松(10mg/体)来改善L-CRS。
结果:第7天,喉头水肿好转,病人可以拔管.
结论:这个案例的教训是,首先,CAR-T细胞治疗可能诱发L-CRS喉部水肿。第二,单独使用TCZ可能对宫颈L-CRS无效。第三,TCZ,以及DEX,可能是不够的。在这种情况下,我们应该认识到L-CRS并及早处理,因为它可能最终发展为需要固定气道的喉水肿.
BACKGROUND: Cytokine release syndrome (CRS) is a common adverse event of chimeric antigen receptor T (CAR-T) cell therapy. CRS is generally a systemic inflammatory reaction, but in rare cases, it can occur in specific body areas and is referred to as \"local CRS (L-CRS).\" A case of laryngeal edema due to L-CRS that required tracheal intubation because of the lack of response to tocilizumab (TCZ) and dexamethasone (DEX) is reported.
METHODS: A 67-year-old woman with relapsed transformed follicular lymphoma was treated with CAR-T cell therapy. Although she had been given TCZ and DEX for CRS, neck swelling appeared on day 4 after infusion.
METHODS: Laryngoscopy showed severe laryngeal edema, which was presumed to be due to L-CRS, since there were no other apparent triggers based on history, physical examination, and computed tomography.
METHODS: Tracheal intubation was performed because of the risk of upper airway obstruction. Ultimately, 4 doses of tocilizumab (8 mg/kg) and 6 doses of dexamethasone (10 mg/body) were required to improve the L-CRS.
RESULTS: On day 7, laryngeal edema improved, and the patient could be extubated.
CONCLUSIONS: The lessons from this case are, first, that CAR-T cell therapy may induce laryngeal edema in L-CRS. Second, TCZ alone may be ineffective in cervical L-CRS. Third, TCZ, as well as DEX, may be inadequate. In such cases, we should recognize L-CRS and manage it early because it may eventually progress to laryngeal edema that requires securing the airway.