Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Blood. 2024 Nov 14;144(20):2083-2094. doi: 10.1182/blood.2024025679.
Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of patients with relapsed or refractory hematologic malignancies, but it comes with unique toxicities, notably cytokine release syndrome and ICANS (immune effector cell-associated neurotoxicity syndrome). As experience with CAR T-cell therapy grows, distinct and infrequent neurologic complications are becoming increasingly evident. Recently, reports of acute myelopathy after the administration of CAR T-cell therapies have been accumulating. Despite the establishment of consensus guidelines for managing ICANS, there remains limited guidance on the appropriate investigations and treatments for this rare complication. In this manuscript, we delve into the clinical features, pathophysiology, and strategies for the optimal management of acute myelitis after CAR T-cell therapy and draw insights from reported cases in the literature.
嵌合抗原受体 (CAR) T 细胞疗法已经彻底改变了复发或难治性血液系统恶性肿瘤患者的治疗方法，但它也带来了独特的毒性，特别是细胞因子释放综合征和 ICANS（免疫效应细胞相关神经毒性综合征）。随着 CAR T 细胞疗法经验的增加，独特且不常见的神经系统并发症越来越明显。最近，越来越多的报告显示，在 CAR T 细胞治疗后会出现急性脊髓病。尽管已经制定了用于管理 ICANS 的共识指南，但对于这种罕见并发症的适当检查和治疗仍然缺乏指导。在本文中，我们深入探讨了 CAR T 细胞治疗后急性脊髓炎的临床特征、病理生理学和最佳管理策略，并从文献中的病例报告中汲取了经验。
