Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Br J Haematol. 2022 Dec;199(5):720-727. doi: 10.1111/bjh.18454. Epub 2022 Sep 16.
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.
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。
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