Rente Lavastida Dianella, De Filippis Samantha, Rivera Torres Eliu G, Aldanese Alexander, Ruxmohan Samir
Clinical Sciences, St. George's University School of Medicine, St. George's, GRD.
Clinical Sciences, University of Medicine and Health Sciences, Camps, KNA.
Cureus. 2024 Jul 27;16(7):e65497. doi: 10.7759/cureus.65497. eCollection 2024 Jul.
Immune cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are both common adverse effects of chimeric antigen receptor (CAR) T-cell therapy. Blinatumomab is a commonly used CAR T-cell treatment in patients with B-cell acute lymphoblastic leukemia (B-ALL). Our patient presented with an extensive past medical history, including refractory B-ALL, and developed CRS and ICANS following treatment with blinatumomab CAR-T cell therapy. Early clinical detection of ICANS, monitoring using immune effector cell encephalopathy scores, following the appropriate protocol for ICANS grade, and adding anakinra (IL-1 receptor antagonist) were crucial steps in managing his condition. The approach to managing and monitoring this patient was unique in that we added anakinra to the standard treatment regimen. With this report, we emphasize the need for further research regarding CAR T-cell therapeutic regimens and how to decrease the morbidity and mortality of its adverse effects.
免疫细胞相关神经毒性综合征（ICANS）和细胞因子释放综合征（CRS）都是嵌合抗原受体（CAR）T细胞疗法常见的不良反应。博纳吐单抗是B细胞急性淋巴细胞白血病（B-ALL）患者常用的CAR T细胞治疗药物。我们的患者有广泛的既往病史，包括难治性B-ALL，在接受博纳吐单抗CAR-T细胞治疗后出现了CRS和ICANS。ICANS的早期临床检测、使用免疫效应细胞脑病评分进行监测、遵循ICANS分级的适当方案以及添加阿那白滞素（IL-1受体拮抗剂）是管理其病情的关键步骤。管理和监测该患者的方法很独特，因为我们在标准治疗方案中添加了阿那白滞素。通过本报告，我们强调需要进一步研究CAR T细胞治疗方案以及如何降低其不良反应的发病率和死亡率。
