Skip to main content
Top

28-05-2024 | CAR T-Cell Therapy | Lessons Learned

CAR-T Cell Therapy and the Neurointensivist

Authors: Eelco F. M. Wijdicks, Alejandro A. Rabinstein, Yi Lin

Published in: Neurocritical Care

Login to get access

Excerpt

We present a 38-year-old female patient with KMT2A-rearranged B cell acute lymphocytic leukemia refractory to multiple lines of therapy, which relapsed within 100 days of allogeneic bone marrow transplantation as transfusion-refractory thrombocytopenia. She was admitted following Brexucabtagene autoleucel chimeric antigen receptors (CAR)-T cell therapy. The clinical course was complicated by immune effector cell–associated hemophagocytic lymphohistiocytosis–like syndrome, improving with tocilizumab, corticosteroids, anakinra, and basiliximab. …
Literature
1.
go back to reference Grant SJ, Grimshaw AA, Silberstein J, Murdaugh D, Wildes TM, Rosko AE, et al. Clinical presentation, risk factors, and outcomes of immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor T cell therapy: a systematic review. Transplant Cell Ther. 2022;28(6):294–302.CrossRefPubMedPubMedCentral Grant SJ, Grimshaw AA, Silberstein J, Murdaugh D, Wildes TM, Rosko AE, et al. Clinical presentation, risk factors, and outcomes of immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor T cell therapy: a systematic review. Transplant Cell Ther. 2022;28(6):294–302.CrossRefPubMedPubMedCentral
2.
go back to reference Rubin DB, Danish HH, Ali AB, Li K, LaRose S, Monk AD, et al. Neurological toxicities associated with chimeric antigen receptor T-cell therapy. Brain. 2019;142(5):1334–48.CrossRefPubMed Rubin DB, Danish HH, Ali AB, Li K, LaRose S, Monk AD, et al. Neurological toxicities associated with chimeric antigen receptor T-cell therapy. Brain. 2019;142(5):1334–48.CrossRefPubMed
3.
go back to reference Santomasso BD, Gust J, Perna F. How I treat unique and difficult-to-manage cases of CAR T-cell therapy-associated neurotoxicity. Blood. 2023;141(20):2443–51.PubMedPubMedCentral Santomasso BD, Gust J, Perna F. How I treat unique and difficult-to-manage cases of CAR T-cell therapy-associated neurotoxicity. Blood. 2023;141(20):2443–51.PubMedPubMedCentral
4.
go back to reference Rebechi MT, Bork JT, Riedel DJ. HHV-6 encephalitis after chimeric antigen receptor T-cell therapy (CAR-T): 2 case reports and a brief review of the literature. Open Forum Infect Dis. 2021;8(11):ofab470.CrossRefPubMedPubMedCentral Rebechi MT, Bork JT, Riedel DJ. HHV-6 encephalitis after chimeric antigen receptor T-cell therapy (CAR-T): 2 case reports and a brief review of the literature. Open Forum Infect Dis. 2021;8(11):ofab470.CrossRefPubMedPubMedCentral
5.
go back to reference Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25.CrossRefPubMed Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914–25.CrossRefPubMed
6.
go back to reference Karschnia P, Jordan JT, Forst DA, Arrillaga-Romany IC, Batchelor TT, Baehring JM, et al. Clinical presentation, management, and biomarkers of neurotoxicity after adoptive immunotherapy with CAR T cells. Blood. 2019;133(20):2212–21.CrossRefPubMed Karschnia P, Jordan JT, Forst DA, Arrillaga-Romany IC, Batchelor TT, Baehring JM, et al. Clinical presentation, management, and biomarkers of neurotoxicity after adoptive immunotherapy with CAR T cells. Blood. 2019;133(20):2212–21.CrossRefPubMed
7.
go back to reference Pensato U, Muccioli L, Zinzani P, D’Angelo R, Pierucci E, Casadei B, et al. Fulminant cerebral edema following CAR T-cell therapy: case report and pathophysiological insights from literature review. J Neurol. 2022;269(8):4560–3.CrossRefPubMedPubMedCentral Pensato U, Muccioli L, Zinzani P, D’Angelo R, Pierucci E, Casadei B, et al. Fulminant cerebral edema following CAR T-cell therapy: case report and pathophysiological insights from literature review. J Neurol. 2022;269(8):4560–3.CrossRefPubMedPubMedCentral
8.
go back to reference Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med. 2017;377(26):2531–44.CrossRefPubMedPubMedCentral Neelapu SS, Locke FL, Bartlett NL, Lekakis LJ, Miklos DB, Jacobson CA, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med. 2017;377(26):2531–44.CrossRefPubMedPubMedCentral
Metadata
Title
CAR-T Cell Therapy and the Neurointensivist
Authors
Eelco F. M. Wijdicks
Alejandro A. Rabinstein
Yi Lin
Publication date
28-05-2024