Double systemic cytokine release syndrome following sequential infusion of anti-CD22 and anti-CD19 chimeric antigen receptor T cells after autologous hematopoietic stem cell transplantation for a central diffuse large B-cell lymphoma patient: A case report and literature review

Frontiers in Immunology

Immunology

Kai B. Gao¹  Jing Zheng¹  Yao Xiao¹  Xue Q. Wu¹  Chun Feng¹  Qiong Z. Xiao² 

[1] Departments of Hematology, The First People s’ Hospital of Yichang, China Three Gorges University, Yichang, Hubei, China;Departments of Internal Medicine, People’s Hospital of Wufeng Tujia Autonomous County, Yichang, Hubei, China;

关键词: chimeric antigen receptor T cell;    cytokine release syndrome;    central diffuse large B-cell lymphoma;    immunotherapy;    adverse reactions;   

DOI  :  10.3389/fimmu.2023.1098815

 received in 2022-11-15, accepted in 2023-01-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundChimeric Antigen Receptor T cell(CAR T-cell) therapy has been a great success in relapsed/refractory acute B lymphoblastic leukemia and B-cell lymphoma. At the same time, there are also related adverse reactions, especially cytokine release syndrome(CRS) and immune effector cell associated neurotoxicity syndrome(ICANS). However, Double CRS caused by CRA T cells are very rare.Case reportHere, we report a 33-year-male with secondary central diffuse large B-cell lymphoma(CNSL) who develpoed double CRS following sequential infusion of Anti-CD22 and Anti-CD19 CAR T cells after autologous hematopoietic stem cell transplantation(ASCT). On d+5, the patient developed high fever, along with chilly sensation, shivering, headache, blood oxygen desaturation, shock, weakness, severe thirst, and heart rate decline. IL-6 and ferritin increased significantly. The patient was diagnosed with the first CRS (grade 3). On d+36, the patient again had a persistent fever(T>39C) and limbs rash. IL-6 and ferritin again increased significantly on d+38. After exclusion of infection, a diagnosis of double CRS was made. The patient’s symptoms were completely relieved after receiving tocilizumab, glucocorticoids, and other supportive treatments on d+45.On d+90, contrast-enhanced MR angiogram shows that the lesion basically disappeared, indicating the patient had achieved CR. At the end of the follow-up at d+150, the patient was functioning normally without any sequelae.ConclusionThis is the first reported case worldwide where the patient with secondary CNSL suffered double CRS after CAR T-cell infusion. Our findings showed that it is important to increase awareness of early detection and diagnosis of double CRS and adopt appropriate treatment strategies.

【 授权许可】

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Copyright © 2023 Zheng, Xiao, Wu, Xiao, Feng and Gao