Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia.
Medical Imaging Department, Royal Children's Hospital, Parkville, Victoria, Australia.
Br J Haematol. 2023 Nov;203(4):651-655. doi: 10.1111/bjh.19015. Epub 2023 Aug 1.
CD19-directed chimeric antigen receptor (CAR) T-cell therapy is an important therapy for relapsed or refractory acute lymphoblastic leukaemia, but its use carries the risk of immune effector cell-associated neurotoxicity syndrome (ICANS). In children, severe ICANS is almost universally reported in association with cytokine release syndrome and is reversible. We describe two cases of severe, intractable neurotoxicity following CAR T-cell therapy in children with pre-existing central nervous system (CNS) vulnerabilities. The cases were atypical in their delayed onset and independence from cytokine release syndrome and did not respond to standard therapies.
CD19 导向嵌合抗原受体 (CAR) T 细胞疗法是治疗复发或难治性急性淋巴细胞白血病的重要方法，但它的使用存在免疫效应细胞相关神经毒性综合征 (ICANS) 的风险。在儿童中，严重的 ICANS 几乎普遍与细胞因子释放综合征相关且是可逆的。我们描述了两例儿童 CAR T 细胞治疗后存在中枢神经系统 (CNS) 脆弱性的情况下发生严重、难治性神经毒性的病例。这些病例的发病时间延迟且与细胞因子释放综合征无关，不典型，且对标准治疗无反应。
