A potential role of preexisting inflammation in the development of acute myelopathy following CAR T-cell therapy for diffuse large B-cell lymphoma

被引：7

作者：

Beauvais, David ^{[1
]}

Cozzani, Adeline ^{[2
]}

Blaise, Anne-Sophie ^{[3
]}

Moreau, Anne-Sophie ^{[4
]}

Varlet, Pauline ^{[1
]}

Gaggero, Silvia ^{[2
]}

Alidjinou, Enagnon Kazali ^{[5
]}

Vannod-Michel, Quentin ^{[6
]}

Morschhauser, Franck ^{[7
]}

Labalette, Myriam ^{[1
]}

Yakoub-Agha, Ibrahim ^{[1
]}

Mitra, Suman ^{[2
]}

机构：

[1] Univ Lille, CHU Lille, INSERM INFINITE U1286, F-59000 Lille, France

[2] Univ Lille, UMR9020 U1277, CHU Lille, CNRS,INSERM,CANTHER Canc Heterogene Plast & Resis, F-59000 Lille, France

[3] Univ Hosp Lille, Dept Neurol, CRC SEP, U1172, Lille, France

[4] CHU Lille, Crit Care Ctr, Lille, France

[5] Univ Lille, CHU Lille, Fac Med, Lab Virol ULR3610, Lille, France

[6] Lille Univ Hosp, Diagnost & Intervent Neuroradiol, Lille, France

[7] Univ Lille, Dept Hematol, CHU Lille, Lille, France

来源：

CURRENT RESEARCH IN TRANSLATIONAL MEDICINE | 2022年 / 70卷 / 02期

关键词：

Non-hodgkin lymphoma; Axi-cel; acute myelopathy; CD19;

D O I：

10.1016/j.retram.2021.103331

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

The event of anti-CD19 chimeric antigen receptor (CAR)-T therapy inducing serious neurotoxicity in patients with diffuse large B-cell lymphoma (DLBCL) is recognized; however, the patterns of symptoms and severity vary greatly from patient to patient. We report an exceptional presentation of acute myelopathy in a refractory DLBCL following successful CAR-T treatment along with grade 3 cytokine release syndrome (CRS) and neurotoxicity. The patient was initiated on high-dose methylprednisolone (MPS) resulting in rapid improvement of neurological symptoms. Yet the myelopathy patient (MP) experienced severe lower limb motor deficit, and a subsequent spinal cord MRI revealed myelopathy with a sensory level at segment T2. Multimodal therapy consisting of MPS, intravenous immunoglobulin and anakinra therapy resulted in complete reversal of myelopathy condition and the patient remained cancer free. The assessment of time trends of serum cytokines at baseline and post CAR-T infusion in MP compared to other 4 DLBCL complete responder patients with varying degree of CRS following CAR-T infusion, suggested pre-existing baseline inflammatory conditions in MP with altered levels of cytokines. These findings, if corroborated by similar case studies, have the potential to generate novel insights into the manifestation of myelopathy following CAR-T therapy and the successful clinical management of such complications. (C) 2022 Elsevier Masson SAS. All rights reserved.

引用

页数：8

共 20 条

[1] A Real-Time Quantitative PCR Targeting the Viral Vector for the Monitoring of Patients Treated with Axicabtagene Ciloleucel [J].