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接受 axi-cel 和 brexu-cel 治疗后类似噬血细胞性淋巴组织细胞增生症的超炎症综合征。

Hyperinflammatory syndrome resembling haemophagocytic lymphohistiocytosis following axicabtagene ciloleucel and brexucabtagene autoleucel.

机构信息

Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

出版信息

Br J Haematol. 2022 Dec;199(5):720-727. doi: 10.1111/bjh.18454. Epub 2022 Sep 16.


DOI:10.1111/bjh.18454
PMID:36111395
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10661175/
Abstract

Haemophagocytic lymphohistiocytosis-like toxicity following chimeric antigen receptor T cells (CAR-HLH) is being increasingly recognized, while published data are limited and criteria for recognition are elusive. We describe three patients who developed CAR-HLH after infusion of brexucabtagene autoleucel (n = 2) or axicabtagene ciloleucel (n = 1). All three patients presented following cytokine release syndrome, with fever, recurrent or worsening cytopenias, hyperferritinaemia, elevated soluble interleukin (IL)-2 receptor, hypofibrinogenaemia, hypertriglyceridaemia, elevated liver transaminases, and decreasing C-reactive protein and IL-6. Clinical improvement following treatment with anakinra (n = 2) and ruxolitinib (n = 1) was observed. Our report offers an opportunity for prompt recognition and initiation of potentially life-saving treatment for CAR-HLH.

摘要

嵌合抗原受体 T 细胞(CAR-T 细胞)相关噬血细胞性淋巴组织细胞增生症样毒性的认识正在不断提高,然而相关的已发表数据有限,且其识别标准也难以捉摸。我们描述了 3 例患者在输注 brexucabtagene autoleucel(n=2)或 axicabtagene ciloleucel(n=1)后发生 CAR-T 细胞相关噬血细胞性淋巴组织细胞增生症样毒性。这 3 例患者均在细胞因子释放综合征后出现发热、反复或加重的血细胞减少、铁蛋白升高、可溶性白细胞介素(IL)-2 受体升高、纤维蛋白原降低、高甘油三酯血症、肝转氨酶升高以及 C 反应蛋白和 IL-6 降低。在接受 anakinra(n=2)和 ruxolitinib(n=1)治疗后观察到临床改善。我们的报告为及时识别和启动可能挽救生命的 CAR-T 细胞相关噬血细胞性淋巴组织细胞增生症样毒性治疗提供了机会。

相似文献

[1]
Hyperinflammatory syndrome resembling haemophagocytic lymphohistiocytosis following axicabtagene ciloleucel and brexucabtagene autoleucel.

Br J Haematol. 2022-12

[2]
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[3]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Chimeric antigen receptor T cell immunotherapy‑associated hemophagocytic lymphohistiocytosis: Pathogenesis, clinical manifestation, diagnosis and management compared with cytokine release syndrome (Review).

Mol Med Rep. 2025-8

[2]
Immune effector cell-associated hematotoxicity: mechanisms, clinical manifestations, and management strategies.

Haematologica. 2025-6-1

[3]
Evolving strategies for addressing CAR T-cell toxicities.

Cancer Metastasis Rev. 2024-12-15

[4]
Mitigating and managing infection risk in adults treated with CAR T-cell therapy.

Hematology Am Soc Hematol Educ Program. 2024-12-6

[5]
Systemic toxicity of CAR-T therapy and potential monitoring indicators for toxicity prevention.

Front Immunol. 2024

[6]
Riding the storm: managing cytokine-related toxicities in CAR-T cell therapy.

Semin Immunopathol. 2024-7-16

[7]
Mechanisms and management of CAR T toxicity.

Front Oncol. 2024-5-21

[8]
Immune Effector Cell-Associated HLH-like Syndrome: A Review of the Literature of an Increasingly Recognized Entity.

Cancers (Basel). 2023-10-26

[9]
Chimeric Antigen Receptor T Cell Therapy for Myeloma: Where Are We Now and What Is Needed to Move Chimeric Antigen Receptor T Cells Forward to Earlier Lines of Therapy? Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy.

Transplant Cell Ther. 2024-1

[10]
Early and Late Toxicities of Chimeric Antigen Receptor T-Cells.

Hematol Oncol Clin North Am. 2023-12

本文引用的文献

[1]
Characterization of HLH-like manifestations as a CRS variant in patients receiving CD22 CAR T cells.

Blood. 2021-12-16

[2]
Consequences of hemophagocytic lymphohistiocytosis-like cytokine release syndrome toxicities and concurrent bacteremia.

Pediatr Blood Cancer. 2021-10

[3]
Hemophagocytic lymphohistiocytosis-like toxicity (carHLH) after CD19-specific CAR T-cell therapy.

Br J Haematol. 2021-8

[4]
Management of hemophagocytic lymphohistiocytosis (HLH) associated with chimeric antigen receptor T-cell (CAR-T) therapy using anti-cytokine therapy: an illustrative case and review of the literature.

Leuk Lymphoma. 2021-7

[5]
Hematopoietic recovery in patients receiving chimeric antigen receptor T-cell therapy for hematologic malignancies.

Blood Adv. 2020-8-11

[6]
Emapalumab in Children with Primary Hemophagocytic Lymphohistiocytosis.

N Engl J Med. 2020-5-7

[7]
Diagnosis and Management of Secondary HLH/MAS Following HSCT and CAR-T Cell Therapy in Adults; A Review of the Literature and a Survey of Practice Within EBMT Centres on Behalf of the Autoimmune Diseases Working Party (ADWP) and Transplant Complications Working Party (TCWP).

Front Immunol. 2020-3-31

[8]
Ruxolitinib in adult patients with secondary haemophagocytic lymphohistiocytosis: an open-label, single-centre, pilot trial.

Lancet Haematol. 2019-12

[9]
Use of Chimeric Antigen Receptor T Cell Therapy in Clinical Practice for Relapsed/Refractory Aggressive B Cell Non-Hodgkin Lymphoma: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy.

Biol Blood Marrow Transplant. 2019-8-22

[10]
Haemophagocytic lymphohistiocytosis has variable time to onset following CD19 chimeric antigen receptor T cell therapy.

Br J Haematol. 2019-10

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