Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Immunol. 2022 Jun 16;13:898341. doi: 10.3389/fimmu.2022.898341. eCollection 2022.
Chimeric antigen receptor T (CAR-T) cell therapy is an attractive strategy for patients with relapsed or refractory hematological malignancies including multiple myeloma (MM). T cells are engineered to attack malignant cells that express tumor-associated antigens and better efficacy could be achieved. However, cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and hematologic toxicity are still challenges for CAR-T cell therapy. Among them, hematologic toxicity including thrombocytopenia has a longer duration and lasting effect during and after the treatment for some patients. Here, we present 3 cases of hematologic toxicity manifested as refractory thrombocytopenia with platelet autoantibodies positive and plasma thrombopoietin (TPO) concentration elevated after bispecific CAR-T cell therapy in relapsed/refractory (R/R) MM patients who were successfully treated with standard therapy of immune thrombocytopenia (ITP). Without clear pathogenesis or guidance on therapy published, our cases provide a reference for the treatment of thrombocytopenia after CAR-T cell therapy and inspire exploration of the underlying pathophysiological mechanisms.
嵌合抗原受体 T（CAR-T）细胞疗法是一种有吸引力的策略，适用于复发或难治性血液系统恶性肿瘤患者，包括多发性骨髓瘤（MM）。T 细胞经过工程改造，可攻击表达肿瘤相关抗原的恶性细胞，从而提高疗效。然而，细胞因子释放综合征（CRS）、免疫效应细胞相关神经毒性综合征（ICANS）和血液学毒性仍然是 CAR-T 细胞治疗的挑战。其中，血液学毒性包括血小板减少症，在某些患者的治疗期间和之后持续时间更长，影响更持久。在这里，我们报告了 3 例血液学毒性表现为难治性血小板减少症，这些患者在复发/难治性（R/R）MM 患者中接受双特异性 CAR-T 细胞治疗后出现血小板自身抗体阳性和血浆血小板生成素（TPO）浓度升高，并通过免疫性血小板减少症（ITP）的标准治疗成功治疗。由于没有明确的发病机制或治疗指导，我们的病例为 CAR-T 细胞治疗后血小板减少症的治疗提供了参考，并激发了对潜在病理生理机制的探索。
