Esposito Pasquale, Gambella Massimiliano, Russo Elisa, Raiola Anna Maria, Beltrametti Elena, Conti Novella, Porcile Elisa, Bianzina Stefania, Centanaro Monica, Viazzi Francesca, Angelucci Emanuele
Department of Internal Medicine (DIMI), University of Genova, Genova, Italy.
Unit of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
Kidney Med. 2025 Apr 3;7(6):101001. doi: 10.1016/j.xkme.2025.101001. eCollection 2025 Jun.
RATIONALE & OBJECTIVE: To describe the use and effects of extracorporeal blood purification with hemoadsorption in managing severe complications after treatment with chimeric antigen receptor T-cells (CAR-T).
Retrospective analysis of a case series.
SETTING & PARTICIPANTS: Hematological department and intensive care unit from a single institution. Patients with hematological cancer who underwent CAR-T therapy between 2021 and 2023, developed severe toxicity, and were treated with hemoadsorption based on clinical indications.
Of 48 patients, extracorporeal blood purification was prescribed to 4 (8.3%): 3 with diffuse large B-cell lymphoma and 1 with mantle cell lymphoma. These patients experienced rapid increases in serum interleukin-6 and ferritin levels after CAR-T infusion, which progressed to severe cytokine release syndrome with hemodynamic instability and multiple-organ toxicity. Despite corticosteroid and anakinra rescue therapy after tocilizumab failure, extracorporeal blood purification with hemoadsorption was initiated at a mean of 5.2 ± 1.7 days following CAR-T infusion due to rapid clinical deterioration. The treatment was performed using continuous venovenous hemodiafiltration with an AN69ST hemofilter and a CytoSorb cartridge. One patient died 1 day after the initiation of blood purification because of concomitant cardiomyopathy progressing to multiple-organ failure. In the 3 surviving patients, interleukin-6 levels significantly decreased (from -18% to -95%), cytokine release syndrome resolved, and vasoactive support was reduced. Treatment-related complications were not observed.
Small sample size, retrospective design, and lack of a predefined hemoadsorption therapy protocol.
A strategy based on hemoadsorption was safe and effective in mitigating inflammation and improving hemodynamics in patients with hematological cancer treated with CAR-T therapy who developed early severe toxicity.
描述血液吸附体外血液净化在嵌合抗原受体T细胞（CAR-T）治疗后严重并发症管理中的应用及效果。
病例系列回顾性分析。
来自单一机构的血液科和重症监护病房。2021年至2023年间接受CAR-T治疗、出现严重毒性并根据临床指征接受血液吸附治疗的血液系统恶性肿瘤患者。
48例患者中，4例（8.3%）接受了体外血液净化治疗：3例弥漫性大B细胞淋巴瘤患者和1例套细胞淋巴瘤患者。这些患者在CAR-T输注后血清白细胞介素-6和铁蛋白水平迅速升高，进展为伴有血流动力学不稳定和多器官毒性的严重细胞因子释放综合征。尽管在托珠单抗治疗失败后使用了皮质类固醇和阿那白滞素抢救治疗，但由于临床迅速恶化，在CAR-T输注后平均5.2±1.7天开始进行血液吸附体外血液净化治疗。治疗采用使用AN69ST血液滤过器和CytoSorb柱的持续静脉-静脉血液透析滤过。1例患者在血液净化开始后1天因并发心肌病进展为多器官衰竭死亡。在3例存活患者中，白细胞介素-6水平显著下降（从-18%降至-95%），细胞因子释放综合征得到缓解，血管活性支持减少。未观察到与治疗相关的并发症。
样本量小、回顾性设计以及缺乏预定义的血液吸附治疗方案。
对于接受CAR-T治疗且出现早期严重毒性的血液系统恶性肿瘤患者，基于血液吸附的策略在减轻炎症和改善血流动力学方面是安全有效的。
