Division of Hematology Oncology, Hollings Cancer Center, 2345Medical University of South Carolina, Charleston, SC, USA.
Department of Pharmacy, 2345Medical University of South Carolina, Charleston, SC, USA.
J Oncol Pharm Pract. 2023 Mar;29(2):473-476. doi: 10.1177/10781552221104816. Epub 2022 May 29.
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.
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.
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.
This case describes the successful use of corticosteroids for the management of ICANS in a patient treated with CAR T-cell therapy for MCL.
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）是嵌合抗原受体（CAR）T 细胞疗法相关的常见毒性。严重的 3 级或更高级别的 ICANS 不太常见，需要使用皮质类固醇，或联合使用白细胞介素（IL）-6 受体拮抗剂。虽然皮质类固醇在 CRS 和 ICANS 的治疗中有效，但它们对 CAR T 疗效的影响尚不清楚。
我们介绍了一例 65 岁男性患者，他因一期/二期套细胞淋巴瘤（MCL）接受了 brexucabtagene autoleucel 的 CAR T 细胞治疗，尽管因严重的 ICANS 接受了长时间的皮质类固醇治疗，但仍获得完全缓解。
患者接受了高剂量皮质类固醇、托珠单抗和阿那白滞素治疗，此外还使用了多种抗癫痫药物。尽管 ICANS 呈缓解-复发模式，但患者不仅从危及生命的并发症中恢复，而且在 CAR T 治疗后三个月还获得了完全缓解。
本病例描述了在接受 CAR T 细胞治疗 MCL 的患者中，使用皮质类固醇成功治疗 ICANS 的情况。
