慢性炎症性脱髓化多神经病变 (CIDP) 在西尔塔细胞治疗后
M Korenkov1, J Liebaert1, S Yousefian1,2,3,4
1Department of Hematology, Oncology and Cancer Immunology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany.
Blood cancer journal
|October 20, 2025
概括
Ciltacabtagene-autoleucel CAR-T疗法可能导致慢性炎症性脱髓化多神经病变 (CIDP). 这种严重的并发症可能来自旁观者T细胞,这表明T细胞消耗疗法可以改善结果.
科学领域:
- 免疫学 免疫学 免疫学
- 神经学 神经学
- 在瘤学瘤学.
背景情况:
- Ciltacabtagene-autoleucel (cilta-cel) 是一种有效的CAR-T治疗复发性/耐药性多发性骨髓瘤的疗法.
- 然而,西尔塔细胞可以导致严重的免疫中介毒性.
研究的目的:
- 描述两例慢性炎症性脱髓化多神经病变 (CIDP) 发生在细胞治疗后的病例.
- 调查这种罕见的不良事件的潜在机制和最佳管理.
主要方法:
- 病例报告两名患者在西尔塔细胞输液后出现神经症状.
- 进行了肌电图,神经传导研究,MRI,CSF分析和TCR-β测序.
- 评估了对高剂量德甲,IVIg和环胺的治疗反应.
主要成果:
- 两位患者都出现了传感运动轴突-脱线神经病变,与CIDP一致.
- 在血液和脑脊液中检测到CAR-T细胞,其中非CAR-T细胞占主导地位.
- 消耗T细胞的环胺使一个患者的病情有所改善,而另一个患者则死于呼吸衰竭.
结论:
- CIDP是一种严重的,可能致命的细胞治疗并发症.
- 致病性可能涉及旁观者自反应性CD8+T细胞扩张,而不仅仅是直接的CAR-T细胞活动.
- 早期的T细胞消耗疗法可能对管理细胞诱导的CIDP至关重要.
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