替西奥仑赛治疗后外周神经受累导致严重运动无力。
Severe Motor Weakness Due to Disturbance in Peripheral Nerves Following Tisagenlecleucel Treatment.
机构信息
Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan;
出版信息
In Vivo. 2021 Nov-Dec;35(6):3407-3411. doi: 10.21873/invivo.12640.
BACKGROUND
Neurotoxicity is one of the dangerous complications of chimeric antigen receptor (CAR) T-cell therapy, while its pathophysiology remains to be fully understood. Motor weakness not associated with central nervous system (CNS) toxicity has rarely been reported after CAR T-cell therapy.
CASE REPORT
A 42-year-old female with a refractory diffuse large B-cell lymphoma received tisagenlecleucel (tisa-cel) and developed cytokine release syndrome (CRS) on day 3. She was treated with tocilizumab and methylprednisolone, which resolved CRS promptly. On day 7, motor weakness in lower extremities appeared, and she gradually became unable to walk without showing any other symptoms attributed to CNS disturbances. Whereas dexamethasone and tocilizumab were ineffective, neuropathy improved after high dose chemotherapy followed by autologous stem cell transplantation. Nerve conduction study (NCS) in lower extremities showed a decline in compound muscle action potential amplitude along with worsening of motor weakness, which was restored after improvement of symptoms. Based on symptoms and NCS, her motor weakness was thought to be due to disturbance in peripheral nerves.
CONCLUSION
This study reports a patient who developed severe motor weakness due to disturbance in peripheral nerves after tisa-cel therapy. Neurotoxicity of non-CNS origin should also be noted in CAR T-cell therapy.
背景
神经毒性是嵌合抗原受体（CAR）T 细胞疗法的一种危险并发症，但其病理生理学仍未完全了解。CAR T 细胞治疗后很少有报道称与中枢神经系统（CNS）毒性无关的运动无力。
病例报告
一名 42 岁女性患有难治性弥漫性大 B 细胞淋巴瘤，接受 tisagenlecleucel（tisa-cel）治疗后，第 3 天出现细胞因子释放综合征（CRS）。她接受了托珠单抗和甲基强的松龙治疗，CRS 迅速得到缓解。第 7 天，下肢出现运动无力，逐渐出现无法行走的症状，而无任何其他归因于 CNS 紊乱的症状。地塞米松和托珠单抗无效，经大剂量化疗后行自体干细胞移植，神经病变改善。下肢神经传导研究（NCS）显示复合肌肉动作电位幅度下降，运动无力加重，症状改善后恢复。基于症状和 NCS，认为她的运动无力是由于周围神经紊乱引起的。
结论
本研究报告了一名患者在接受 tisa-cel 治疗后因周围神经紊乱而出现严重运动无力。在 CAR T 细胞治疗中也应注意非 CNS 起源的神经毒性。
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