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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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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fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10257532</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2831715199</sourcerecordid><originalsourceid>FETCH-LOGICAL-c310t-ca6faf969e19be9bed6237f272aedceb111a6730aea7f562e6a102bb8405e8623</originalsourceid><addsrcrecordid>eNpVkVFr1TAUx4M43Jh781kCvtotadamfZJZnRsUJvOKj-E09_Q2s01q0k76cfympt5tTAhJIL_zOyf8CXnD2amUWXmmZ49zOBVFybIX5CjleZEUvDh_-ex-SE5CuGOMcSZTJtkrciikYELk6RH5U6G_Nxp6Wrt1r5bJ_TQW6S32CAHpt8VuvRuQXrq-d7-N3dGqMwN6o-mFncwObWQ1jpPzdJNo7Hu66dDDuFBj6VeYDNop0B9m6lYpjAG3NLK32HrQsWqhn0zbzrFXDX6H9ONeUi_D2LkBXpODFvqAJw_nMfl--XlTXSX1zZfr6qJOtOBsSjTkLbRlXiIvG4xrm6dCtqlMAbcaG8455PHbgCDbLE8xB87SpinOWYZFZI_Jh713nJthLbGTh16N3gzgF-XAqP9frOnUzt2rqMlkJlbDuweDd79mDJO6c7O3cWiVFoJLnvGyjNT7PaW9C8Fj-9SCM7WGqvahqn-hRvzt87Ge4McIxV_XZaIk</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2831715199</pqid></control><display><type>article</type><title>Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma</title><source>PubMed Central Open Access</source><source>PubMed Central</source><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</creator><creatorcontrib>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</creatorcontrib><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.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.38905</identifier><identifier>PMID: 37303362</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>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</subject><ispartof>Curēus (Palo Alto, CA), 2023-05, Vol.15 (5), p.e38905</ispartof><rights>Copyright © 2023, Inoue et al.</rights><rights>Copyright © 2023, Inoue et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2023, Inoue et al. 2023 Inoue et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c310t-ca6faf969e19be9bed6237f272aedceb111a6730aea7f562e6a102bb8405e8623</citedby><cites>FETCH-LOGICAL-c310t-ca6faf969e19be9bed6237f272aedceb111a6730aea7f562e6a102bb8405e8623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257532/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257532/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,886,27928,27929,53795,53797</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37303362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Inoue, Yu</creatorcontrib><creatorcontrib>Fujino, Takahiro</creatorcontrib><creatorcontrib>Chinen, Shotaro</creatorcontrib><creatorcontrib>Niiyama-Uchibori, Yui</creatorcontrib><creatorcontrib>Ide, Daisuke</creatorcontrib><creatorcontrib>Kawata, Moe</creatorcontrib><creatorcontrib>Hashimoto, Keiko</creatorcontrib><creatorcontrib>Takimoto-Shimomura, Tomoko</creatorcontrib><creatorcontrib>Nakayama, Ai</creatorcontrib><creatorcontrib>Tsukamoto, Taku</creatorcontrib><creatorcontrib>Mizutani, Shinsuke</creatorcontrib><creatorcontrib>Shimura, Yuji</creatorcontrib><creatorcontrib>Hirano, Shigeru</creatorcontrib><creatorcontrib>Kuroda, Junya</creatorcontrib><title>Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><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.</description><subject>Airway management</subject><subject>Antigens</subject><subject>Blood tests</subject><subject>Cytokine storm</subject><subject>Cytokines</subject><subject>Dyspnea</subject><subject>Edema</subject><subject>Hematology</subject><subject>Hemoglobin</subject><subject>Leukocytes</subject><subject>Lymphatic system</subject><subject>Lymphocytes</subject><subject>Lymphoma</subject><subject>Metabolism</subject><subject>Monoclonal antibodies</subject><subject>Neck</subject><subject>Neutrophils</subject><subject>Oncology</subject><subject>Otolaryngology</subject><subject>Patients</subject><subject>Serology</subject><subject>Steroids</subject><subject>Tomography</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpVkVFr1TAUx4M43Jh781kCvtotadamfZJZnRsUJvOKj-E09_Q2s01q0k76cfympt5tTAhJIL_zOyf8CXnD2amUWXmmZ49zOBVFybIX5CjleZEUvDh_-ex-SE5CuGOMcSZTJtkrciikYELk6RH5U6G_Nxp6Wrt1r5bJ_TQW6S32CAHpt8VuvRuQXrq-d7-N3dGqMwN6o-mFncwObWQ1jpPzdJNo7Hu66dDDuFBj6VeYDNop0B9m6lYpjAG3NLK32HrQsWqhn0zbzrFXDX6H9ONeUi_D2LkBXpODFvqAJw_nMfl--XlTXSX1zZfr6qJOtOBsSjTkLbRlXiIvG4xrm6dCtqlMAbcaG8455PHbgCDbLE8xB87SpinOWYZFZI_Jh713nJthLbGTh16N3gzgF-XAqP9frOnUzt2rqMlkJlbDuweDd79mDJO6c7O3cWiVFoJLnvGyjNT7PaW9C8Fj-9SCM7WGqvahqn-hRvzt87Ge4McIxV_XZaIk</recordid><startdate>20230511</startdate><enddate>20230511</enddate><creator>Inoue, Yu</creator><creator>Fujino, Takahiro</creator><creator>Chinen, Shotaro</creator><creator>Niiyama-Uchibori, Yui</creator><creator>Ide, Daisuke</creator><creator>Kawata, Moe</creator><creator>Hashimoto, Keiko</creator><creator>Takimoto-Shimomura, Tomoko</creator><creator>Nakayama, Ai</creator><creator>Tsukamoto, Taku</creator><creator>Mizutani, Shinsuke</creator><creator>Shimura, Yuji</creator><creator>Hirano, Shigeru</creator><creator>Kuroda, Junya</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope></search><sort><creationdate>20230511</creationdate><title>Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c310t-ca6faf969e19be9bed6237f272aedceb111a6730aea7f562e6a102bb8405e8623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Airway management</topic><topic>Antigens</topic><topic>Blood tests</topic><topic>Cytokine storm</topic><topic>Cytokines</topic><topic>Dyspnea</topic><topic>Edema</topic><topic>Hematology</topic><topic>Hemoglobin</topic><topic>Leukocytes</topic><topic>Lymphatic system</topic><topic>Lymphocytes</topic><topic>Lymphoma</topic><topic>Metabolism</topic><topic>Monoclonal antibodies</topic><topic>Neck</topic><topic>Neutrophils</topic><topic>Oncology</topic><topic>Otolaryngology</topic><topic>Patients</topic><topic>Serology</topic><topic>Steroids</topic><topic>Tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Inoue, Yu</creatorcontrib><creatorcontrib>Fujino, Takahiro</creatorcontrib><creatorcontrib>Chinen, Shotaro</creatorcontrib><creatorcontrib>Niiyama-Uchibori, Yui</creatorcontrib><creatorcontrib>Ide, Daisuke</creatorcontrib><creatorcontrib>Kawata, Moe</creatorcontrib><creatorcontrib>Hashimoto, Keiko</creatorcontrib><creatorcontrib>Takimoto-Shimomura, Tomoko</creatorcontrib><creatorcontrib>Nakayama, Ai</creatorcontrib><creatorcontrib>Tsukamoto, Taku</creatorcontrib><creatorcontrib>Mizutani, Shinsuke</creatorcontrib><creatorcontrib>Shimura, Yuji</creatorcontrib><creatorcontrib>Hirano, Shigeru</creatorcontrib><creatorcontrib>Kuroda, Junya</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Inoue, Yu</au><au>Fujino, Takahiro</au><au>Chinen, Shotaro</au><au>Niiyama-Uchibori, Yui</au><au>Ide, Daisuke</au><au>Kawata, Moe</au><au>Hashimoto, Keiko</au><au>Takimoto-Shimomura, Tomoko</au><au>Nakayama, Ai</au><au>Tsukamoto, Taku</au><au>Mizutani, Shinsuke</au><au>Shimura, Yuji</au><au>Hirano, Shigeru</au><au>Kuroda, Junya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cervical Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-cell Therapy in Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2023-05-11</date><risdate>2023</risdate><volume>15</volume><issue>5</issue><spage>e38905</spage><pages>e38905-</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>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.</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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