Constantinescu Catalin, Pasca Sergiu, Tat Tiberiu, Teodorescu Patric, Vlad Catalin, Iluta Sabina, Dima Delia, Tomescu Dana, Scarlatescu Ecaterina, Tanase Alina, Sigurjonsson Olafur Eysteinn, Colita Anca, Einsele Hermann, Tomuleasa Ciprian
Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
Department of Anesthesia - Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.
J Immunother Cancer. 2020 May;8(1). doi: 10.1136/jitc-2020-000742.
Recently, an increasing number of novel drugs were approved in oncology and hematology. Nevertheless, pharmacology progress comes with a variety of side effects, of which cytokine release syndrome (CRS) is a potential complication of some immunotherapies that can lead to multiorgan failure if not diagnosed and treated accordingly. CRS generally occurs with therapies that lead to highly activated T cells, like chimeric antigen receptor T cells or in the case of bispecific T-cell engaging antibodies. This, in turn, leads to a proinflammatory state with subsequent organ damage. To better manage CRS there is a need for specific therapies or to repurpose strategies that are already known to be useful in similar situations. Current management strategies for CRS are represented by anticytokine directed therapies and corticosteroids. Based on its pathophysiology and the resemblance of CRS to sepsis and septic shock, as well as based on the principles of initiation of continuous renal replacement therapy (CRRT) in sepsis, we propose the rationale of using CRRT therapy as an adjunct treatment in CRS where all the other approaches have failed in controlling the clinically significant manifestations.
最近，越来越多的新型药物在肿瘤学和血液学领域获得批准。然而，药理学的进展伴随着各种副作用，其中细胞因子释放综合征（CRS）是一些免疫疗法的潜在并发症，如果不及时诊断和治疗，可能会导致多器官功能衰竭。CRS通常发生在导致T细胞高度活化的治疗中，如嵌合抗原受体T细胞疗法或双特异性T细胞衔接抗体治疗的情况下。这反过来又会导致促炎状态，随后造成器官损伤。为了更好地管理CRS，需要特定的治疗方法，或者重新采用已知在类似情况下有用的策略。目前CRS的管理策略以抗细胞因子导向疗法和皮质类固醇为代表。基于其病理生理学以及CRS与脓毒症和脓毒性休克的相似性，以及基于脓毒症中启动连续性肾脏替代疗法（CRRT）的原则，我们提出在所有其他方法均未能控制临床显著表现的CRS中，将CRRT疗法用作辅助治疗的基本原理。
