Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma

The use of chimeric antigen receptor T-cell (CAR-T) therapy for hematologic malignancies is rapidly increasing, and appropriately managing adverse events (AEs) is crucial. Cytokine release syndrome (CRS) is a common AE of CAR-T therapy, characterized by systemic symptoms such as fever and respire-ci...

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Veröffentlicht in:Curēus (Palo Alto, CA) CA), 2023-05, Vol.15 (5), p.e38905
Hauptverfasser: Inoue, Yu, Fujino, Takahiro, Chinen, Shotaro, Niiyama-Uchibori, Yui, Ide, Daisuke, Kawata, Moe, Hashimoto, Keiko, Takimoto-Shimomura, Tomoko, Nakayama, Ai, Tsukamoto, Taku, Mizutani, Shinsuke, Shimura, Yuji, Hirano, Shigeru, Kuroda, Junya
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container_issue 5
container_start_page e38905
container_title Curēus (Palo Alto, CA)
container_volume 15
creator Inoue, Yu
Fujino, Takahiro
Chinen, Shotaro
Niiyama-Uchibori, Yui
Ide, Daisuke
Kawata, Moe
Hashimoto, Keiko
Takimoto-Shimomura, Tomoko
Nakayama, Ai
Tsukamoto, Taku
Mizutani, Shinsuke
Shimura, Yuji
Hirano, Shigeru
Kuroda, Junya
description The use of chimeric antigen receptor T-cell (CAR-T) therapy for hematologic malignancies is rapidly increasing, and appropriately managing adverse events (AEs) is crucial. Cytokine release syndrome (CRS) is a common AE of CAR-T therapy, characterized by systemic symptoms such as fever and respire-circulatory failure. We present two cases with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) accompanied by a rare complication of cervical local CRS as an acute inflammatory reaction at a specific site after CAR-T infusion. Case 1: A 60-year-old gentleman with diffuse large B cell lymphoma (DLBCL) developed grade 1 CRS on day one that required three doses of tocilizumab. Then he developed remarkable cervical edema as local CRS on day five. His local CRS spontaneously improved from day seven without additional therapy. Case 2: A 70-year-old gentleman with DLBCL developed grade 1 CRS on day two that required three doses of tocilizumab. Then he developed remarkable cervical edema and muffled voice as local CRS on day three. He received dexamethasone because of concerns about airway obstruction, and his local CRS improved immediately after dexamethasone administration. Before Tisa-Cel infusion, neither patients had a lymphoma lesion in their necks. To summarize, local CRS may occur at the site without lymphoma involvement after CAR-T therapy. An appropriate diagnosis and careful observation are required to determine the need for additional treatment.
doi_str_mv 10.7759/cureus.38905
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He received dexamethasone because of concerns about airway obstruction, and his local CRS improved immediately after dexamethasone administration. Before Tisa-Cel infusion, neither patients had a lymphoma lesion in their necks. To summarize, local CRS may occur at the site without lymphoma involvement after CAR-T therapy. 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Cytokine release syndrome (CRS) is a common AE of CAR-T therapy, characterized by systemic symptoms such as fever and respire-circulatory failure. We present two cases with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) accompanied by a rare complication of cervical local CRS as an acute inflammatory reaction at a specific site after CAR-T infusion. Case 1: A 60-year-old gentleman with diffuse large B cell lymphoma (DLBCL) developed grade 1 CRS on day one that required three doses of tocilizumab. Then he developed remarkable cervical edema as local CRS on day five. His local CRS spontaneously improved from day seven without additional therapy. Case 2: A 70-year-old gentleman with DLBCL developed grade 1 CRS on day two that required three doses of tocilizumab. Then he developed remarkable cervical edema and muffled voice as local CRS on day three. He received dexamethasone because of concerns about airway obstruction, and his local CRS improved immediately after dexamethasone administration. Before Tisa-Cel infusion, neither patients had a lymphoma lesion in their necks. To summarize, local CRS may occur at the site without lymphoma involvement after CAR-T therapy. An appropriate diagnosis and careful observation are required to determine the need for additional treatment.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>37303362</pmid><doi>10.7759/cureus.38905</doi><oa>free_for_read</oa></addata></record>
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subjects Airway management
Antigens
Blood tests
Cytokine storm
Cytokines
Dyspnea
Edema
Hematology
Hemoglobin
Leukocytes
Lymphatic system
Lymphocytes
Lymphoma
Metabolism
Monoclonal antibodies
Neck
Neutrophils
Oncology
Otolaryngology
Patients
Serology
Steroids
Tomography
title Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma
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