Ruff Michael W, Siegler Elizabeth L, Kenderian Saad S
T Cell Engineering, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
T Cell Engineering, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Hematology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Neurol Clin. 2020 Nov;38(4):953-963. doi: 10.1016/j.ncl.2020.08.001. Epub 2020 Sep 12.
Chimeric antigen receptor-engineered T (CAR-T) cell immunotherapy has been successful in treating many types of hematological malignancies. CAR-T therapy, however, has been associated with toxicities, including cytokine release syndrome (CRS) as well as immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS presentation is variable, largely reversible, and manifests with encephalopathy and focal neurologic deficits. Treatment strategies largely are supportive. ICANS pathophysiology likely is related to that of CRS. Preclinical studies and clinical experience have shed light on the driving forces of ICANS and have yielded new strategies to mitigate ICANS occurrence.
嵌合抗原受体工程化T（CAR-T）细胞免疫疗法已成功用于治疗多种血液系统恶性肿瘤。然而，CAR-T疗法存在毒性，包括细胞因子释放综合征（CRS）以及免疫效应细胞相关神经毒性综合征（ICANS）。ICANS的表现多样，大多可逆转，表现为脑病和局灶性神经功能缺损。治疗策略主要是支持性的。ICANS的病理生理学可能与CRS相关。临床前研究和临床经验已阐明ICANS的驱动因素，并产生了减轻ICANS发生的新策略。
