Wirk Baldeep, Lim Jin
Cellular Immunotherapies and Transplant Program, Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, VA 23219, USA.
Department of Radiology, Virginia Commonwealth University, Richmond, VA 23219, USA.
J Hematol. 2025 Jun;14(3):146-151. doi: 10.14740/jh2046. Epub 2025 Apr 22.
After ciltacabtagene autoleucel (cilta-cel) in multiple myeloma, 5% of patients can develop parkinsonism, with a high fatality rate. The pathogenesis and optimal therapy of parkinsonism from B-cell maturation antigen chimeric antigen receptor T-cell (CAR T-cell) therapy are unknown. Parkinson's disease occurs from the loss of dopaminergic neurons in the substantia nigra. However, in cilta-cel-associated parkinsonism, dopamine transporter imaging is normal, rendering traditional agents such as carbidopa/levodopa ineffective. Thus, the pathogenesis of cilta-cel-associated parkinsonism and Parkinson's disease is distinct. As CAR T-cell therapy for multiple myeloma is expanding and moving to earlier lines, the need to optimize therapy for parkinsonism, a potentially life-threatening complication, becomes more urgent. This report presents the first documented cases of two patients with immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome and cilta-cel-associated parkinsonism, effectively treated with ruxolitinib.
在多发性骨髓瘤患者接受西达基奥仑赛（cilta-cel）治疗后，5%的患者会出现帕金森综合征，且死亡率很高。B细胞成熟抗原嵌合抗原受体T细胞（CAR T细胞）疗法导致帕金森综合征的发病机制和最佳治疗方法尚不清楚。帕金森病是由黑质中多巴胺能神经元的丧失引起的。然而，在西达基奥仑赛相关的帕金森综合征中，多巴胺转运体成像正常，这使得卡比多巴/左旋多巴等传统药物无效。因此，西达基奥仑赛相关帕金森综合征和帕金森病的发病机制是不同的。随着用于多发性骨髓瘤的CAR T细胞疗法不断扩展并应用于更早期的治疗阶段，优化对帕金森综合征（一种可能危及生命的并发症）的治疗变得更加迫切。本报告介绍了首例有记录的两名患有免疫效应细胞相关噬血细胞性淋巴组织细胞增生症样综合征和西达基奥仑赛相关帕金森综合征的患者，他们接受芦可替尼治疗后效果良好。
