与CAR T细胞相关的急性骨髓病变:一种罕见但至关重要的神经毒性,需要识别
Céline Everard1, Gilles Crochet2, Alissa Silva Gomes3
1Intensive Care Unit, Mont Godinne University Hospital, CHU UCL Namur, Yvoir, Belgium.
Acta neurologica Belgica
|December 4, 2025
概括
虽然CAR-T细胞疗法对血液癌症有效,但可以导致罕见的神经系统问题,如脑膜炎. 这一案例凸显了接受CAR-T治疗的重症患者的诊断挑战和早期干预的需要.
科学领域:
- 在瘤学瘤学.
- 神经学 神经学
- 免疫治疗是一种免疫疗法.
背景情况:
- 化学抗原受体T细胞 (CAR-T) 疗法为血液恶性瘤提供了改善的结果.
- 神经系统并发症,包括免疫效应细胞相关的神经毒性综合征 (ICANS),是已知的风险.
- 罕见但严重的神经事件超出ICANS,如急性骨髓病变,可以发生.
研究的目的:
- 报告在CAR-T细胞治疗后发生的脊髓炎病例.
- 突出诊断挑战的脊髓卷入危急病患者的脊髓.
- 强调早期识别和多学科管理对罕见的CAR-T相关的神经并发症的重要性.
主要方法:
- 一个59岁的女性患者的病例报告,她接受了针对CD19的CAR-T细胞治疗,以治疗复发性淋巴瘤.
- 记录了临床表现,诊断工作和治疗过程.
- 排除了替代诊断,以将骨髓炎归因于CAR T细胞治疗.
主要成果:
- 患者患有IV级ICANS,随后发生骨髓炎.
- 尽管进行了积极的免疫抑制治疗和支持性护理,但神经系统无法恢复.
- 椎脊髓损伤导致呼吸机依赖,最终导致死亡.
结论:
- 卡特-T细胞疗法可能导致罕见的,严重的神经并发症,如骨髓炎.
- 由于混因素,在重症监护室设置中存在诊断挑战.
- 及时的神经学评估和多学科管理对于潜在地预防长期后果至关重要.
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