Chimeric antigen receptor T-associated cytokines release syndrome managed by therapeutic plasma exchange and tumor necrosis factor inhibitors: a case report

Abstract

Objective To learn more about the role of therapeutic plasma exchange in the management of cytokines release syndrome(CRS) after chimeric antigen receptor T(CAR-T) infusion by reviewing and analyzing the diagnosis and treatment of one case. Methods The diagnosis and treatment of lymphoma patients with CAR-T infusion related CRS were described, and case analysis was carried out by searching PubMed, Elsevier, Wiley, CNKI, and other databases for relevant guidelines, clinical trials, and case reports. Results The patient was diagnosed with follicular cell lymphoma. Progressive disease(PD) was assessed after multiple courses of treatment, and anti-CD19/20 CAR-T cell therapy was administered.The patient developed a high fever and chills, secondary dyspnea and hypotension at night on the day of infusion, and the inflammatory factors such as C-reactive protein(CRP) and interleukin-6(IL-6) increased sharply, suggesting the occurrence of cytokines release syndrome(CRS). After the patient was given symptomatic antipyretic, broad-spectrum anti-infection, tumor necrosis factor(TNF) antibody and three occasions of plasma exchange, the clinical manifestations of CRS gradually relieved. Three months after discharge, the patient was in complete response(CR). Conclusion CAR-T-associated CRS is a serious cellular immunotherapy-related toxicity that can result in multiple organ failure or even death in patients. Therapeutic plasma exchange may be a potential treatment for some patients with severe CRS.

Keywords

• therapeutic plasma exchange
• cytokines release syndrome
• car-t