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在儿童中,与CAR T治疗相关的严重持续性神经毒性

Eden C Andrew¹, David Hughes¹, Maddie Gilsenan¹

¹Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia.

British journal of haematology

|August 2, 2023

概括

化学抗原受体 (CAR) T细胞治疗急性淋巴细胞白血病可能导致神经毒性. 两个儿科病例显示出严重的,延迟的神经毒性,独立于细胞因子释放综合征,对标准治疗无反应.

科学领域:

在瘤学瘤学.
免疫治疗是一种免疫疗法.
儿科血液学/瘤学

背景情况:

CD19导向的化学抗原受体 (CAR) T细胞疗法是复发性或耐火性急性淋巴细胞白血病的重要治疗方法.
免疫效应细胞相关神经毒性综合征 (ICANS) 是CAR T细胞治疗的一个已知的风险.
在儿科患者中,严重的ICANS通常与细胞因子释放综合征发生,并且是可逆的.

研究的目的:

在儿童接受CAR T细胞治疗后,描述了两例严重的,难以治疗的神经毒性病例.
突出神经毒性的非典型表现,包括延迟发病和独立于细胞因子释放综合征.
为了研究先前存在中枢神经系统 (CNS) 漏洞的儿科患者的神经毒性.

主要方法:

案例报告的方法.
详细的临床观察和两名接受CAR T细胞治疗的儿科患者的记录.
分析神经毒性表现,时间,与细胞因子释放综合征的关联,以及对干预措施的反应.

主要成果:

两名儿童在CAR T细胞治疗后出现了严重的,难以治疗的神经毒性.
神经毒性呈现出延迟发作,并且与细胞因子释放综合征无关.
在这些情况下,ICANS的标准治疗干预措施是无效的.

结论:

在儿童接受CAR T细胞治疗后,即使没有细胞因子释放综合征,也可能发生严重的,难以治疗的神经毒性.
患有先前存在的中枢神经系统脆弱性的儿科患者可能面临更高的非典型神经毒性风险.
需要进一步的研究来理解和管理这些严重的,耐治疗的神经毒性事件.

关键词:

通过CAR T细胞疗法进行治疗.免疫效应细胞相关的神经毒性综合征免疫疗法免疫疗法这种白血病是白血病.神经毒性的作用.

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