Intracranial pressure management in fulminant cerebral oedema after CAR T‐cell therapy: Not all is lost!

作者：Gian Maria Asioli, Carlo Alberto Castioni, Pier Luigi Zinzani, Maria Chiara Casadio, Elisabetta Pierucci, Beatrice Casadei, Luca Spinardi, Cinzia Pellegrini, Massimiliano Bonafè, Enrico Maffini, Maria Guarino, Pietro Cortelli, Francesca Bonifazi · 发表于：British Journal of Haematology · 年份：2023 · DOI：10.1111/bjh.19270 · 被引用次数：4 · 研究领域：CAR-T cell therapy research、Neuroscience and Neural Engineering、Glioma Diagnosis and Treatment

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a well-known complication after CAR T therapy with a relevant impact on morbidity and even mortality.1 ICANS manifestations may range from mild encephalopathy with predominant language disturbances to coma or death due to fulminant cerebral oedema (FCO).2 FCE is the most extreme neurological complication after Chimeric antigen receptor (CAR) T-cell therapy. It occurs with a rapid neurological deterioration, which typically leads to brain death within 24 h. Although it is a rare adverse event (estimated incidence 1%–2%), the cases described so far have shown an almost invariably fatal evolution.1-6 Hereby, we describe a case of CAR T-cell-related FCE successfully treated with a prompt neurointensive support in addition to immunosuppressive anti-cytokine therapy. The patient, a 55-year-old woman suffering from follicular non-Hodgkin B-cell lymphoma grade 3 B transformed from grade 2 follicular lymphoma, was a candidate for CAR T-cell therapy as the fifth line after the fourth untreated relapse (infradiaphragmatic lymphadenopathy). She was previously administered rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, Ifosfamide, epirubicin and etoposide, idelasinib and an experimental protocol with obinutuzumab and a BTK inhibitor. Her past medical history was also remarkable for a breast ductal carcinoma treated with quadrantectomy and radiotherapy 3 years earlier with a negative oncological follo...