肿瘤细胞治疗研究
英文原题：Case Report: Chimeric Antigen Receptor T Cells Induced Late Severe Cytokine Release Syndrome.
重度CRS可能发生在CART治疗后期，因为CART细胞的再扩增具有迟发性sCRS的潜在风险。
重度细胞因子释放综合征（sCRS）已成为CAR-T 细胞（CART）治疗早期的严重并发症，而sCRS是否发生在晚期仍不清楚。在此，我们报告了两例晚期sCRS患者。病例介绍：病例1为一名34岁女性，患有难治性费城染色体阳性B细胞急性淋巴细胞白血病。她获得完全缓解（CR），但在输注CD19靶向CART（CART19）细胞和CD22靶向CART（CART22）细胞后41天出现III级CRS和噬血细胞性淋巴组织细胞增生症（HLH）。对托珠单抗和HLH-94方案（地塞米松和依托泊苷）无效，她在CART治疗后第55天死于脑出血。病例2为一名38岁男性，患有IgG kappa多发性骨髓瘤。他在HLA相合同胞（姐妹）供者移植后4个月接受自体BCMA靶向CART（BCMA-CART）治疗，并在CART给药后163天出现III级CRS，表现为发热、低血压和皮肤病变。对甲泼尼龙和托珠单抗有效，他的临床缓解持续超过6.0个月。
BACKGROUND: Severe cytokine release syndrome (sCRS) has emerged as an adverse complication in the early period of chimeric antigen receptor T cell (CART) therapy, while whether sCRS occurs in the late period remains unknown. Here, we reported two patients with late sCRS. CASE PRESENTATION: Case 1 was a 34-year-old female with refractory Philadelphia chromosome-positive B cell acute lymphoblastic leukemia. She achieved complete remission (CR) but experienced grade III CRS and hemophagocytic lymphohistiocytosis (HLH) 41 days after CD19-targeted CART (CART19) cells and CD22-targeted CART (CART22) cells infusion. Ineffective to tocilizumab and HLH-94 protocol (dexamethasone and etoposide), she died of a cerebral hemorrhage on day 55 after CART therapy. Case 2 was a 38-year-old male with IgG kappa multiple myeloma. He received autologous BCMA-targeted CART (BCMA-CART) therapy 4 months after HLA-matched sibling (sister) donor transplantation and developed grade III CRS 163 days after CART administration, characterized by fever, hypotension, and skin lesions. Effective to methylprednisolone and tocilizumab, his clinical response persisted for over 6.0 months. CONCLUSION: Severe CRS could occur in the late period after CART therapy as re-expansion of CART cells possessed the potential risk for late sCRS.
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