肿瘤细胞治疗研究
英文原题：Severe Cytokine Release Syndrome After CAR T Cell Therapy in a Pediatric Patient With Relapsed ALL.
Severe Cytokine Release Syndrome After CAR T Cell Therapy in a Pediatric Patient With Relapsed ALL.
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本病例凸显了难治性儿童 CRS 的实用床旁序贯治疗与升级，并提示在一线治疗不充分时持续静脉注射 anakinra 和 emapalumab 可能具有潜在作用。
**背景：**细胞因子释放综合征（CRS）是嵌合抗原受体（CAR）T细胞治疗可能危及生命的并发症，在儿童复发性急性淋巴细胞白血病（ALL）患者中尤为重要。 **病例介绍：**一名7岁男童患低二倍体ALL并早期骨髓复发，接受抗CD19 CAR-T 细胞后发生重度CRS，表现为持续发热、低血压、低氧血症、脑病和多器官功能障碍，需入住儿童重症监护病房。 **处理：**患者接受托珠单抗、大剂量地塞米松、持续静脉输注阿那白滞素及依马鲁单抗，并给予高级生命支持，包括机械通气、升压药和持续肾脏替代治疗。序贯多药免疫调节与血流动力学暂时稳定相关。 **结论：**该病例展示儿童难治性CRS床旁治疗中实际的用药顺序和升级策略，并提示当一线治疗不足时，持续静脉输注阿那白滞素及依马鲁单抗可能具有作用。
Cytokine release syndrome (CRS) is a potentially life-threatening complication of chimeric antigen receptor (CAR) T cell therapy, particularly in pediatric relapsed acute lymphoblastic leukemia (ALL). CASE PRESENTATION: A 7-year-old boy with early bone-marrow relapse of hypodiploid ALL received anti-CD19 CAR T cells and developed severe CRS with persistent fever, hypotension, hypoxemia, encephalopathy, and multiorgan dysfunction requiring pediatric intensive care. MANAGEMENT: He received tocilizumab, high-dose dexamethasone, continuous intravenous (IV) anakinra, and emapalumab, plus advanced supportive care (mechanical ventilation, vasopressors, and continuous renal replacement therapy). Sequential, multiagent immunomodulation was associated with transient hemodynamic stabilization.
This case highlights practical bedside sequencing and escalation for refractory pediatric CRS and suggests a potential role for continuous IV anakinra and emapalumab when first-line therapy is inadequate.
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