血浆置换联合抗肿瘤坏死因子抗体治疗CAR-T细胞相关细胞因子释放综合征1例  

Chimeric antigen receptor T-associated cytokines release syndrome managed by therapeutic plasma exchange and tumor necrosis factor inhibitors:a case report

作　　者：张鹭 刘晓敏[2] 庄远[2] 张雷英 汪德清[2] ZHANG Lu;LIU Xiaomin;ZHUANG Yuan;ZHANG Leiying;WANG Deqing(Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,China;The First Medical Center of Chinese PLA General Hospital)

机构地区：[1]四川省医学科学院·四川省人民医院,四川成都610072 [2]解放军总医院第一医学中心

出　　处：《中国输血杂志》2022年第6期664-667,共4页Chinese Journal of Blood Transfusion

摘　　要：目的通过对1例CAR-T输注后CRS的诊治过程进行回顾及分析,探究血浆置换对于管理此类毒性的作用。方法描述本例患CAR-T输注相关CRS的淋巴瘤患者的诊治经过,结合PubMed,Elsevier,Wiley,CNKI等数据库检索相关指南和临床实验或病例报告进行病例分析。结果患者诊断为滤泡细胞淋巴瘤,经多线、多疗程治疗后,评估疾病进展(progressive disease,PD),给予抗CD19/20 CAR-T细胞治疗。患者于输注细胞当天夜间出现高热、寒战,继发呼吸困难和低血压,并有C反应蛋白(C reactive protein,CRP)、白细胞介素-6(Interleukin,IL-6)等炎症因子急剧升高,提示患者发生细胞因子释放综合征(Cytokines release syndrome,CRS)。给予患者对症退热、广谱抗感染、肿瘤坏死因子(Tumor necrosis factor,TNF)抗体及前后3次血浆置换治疗。CRS相关的临床表现逐渐缓解,出院后3个月原发病评估疗效为持续完全缓解(complete response,CR)。结论CAR-T细胞输注相关的CRS是细胞免疫治疗较为严重的毒性反应,可能导致患者多器官衰竭甚至致命。血浆置换可能成为一些严重的CRS患者的治疗选择之一。Objective To learn more about the role of therapeutic plasma exchange in the management of cytokines release syndrome(CRS)after chimeric antigen receptor T(CAR-T)infusion by reviewing and analyzing the diagnosis and treatment of one case.Methods The diagnosis and treatment of lymphoma patients with CAR-T infusion related CRS were described,and case analysis was carried out by searching PubMed,Elsevier,Wiley,CNKI,and other databases for relevant guidelines,clinical trials,and case reports.Results The patient was diagnosed with follicular cell lymphoma.Progressive disease(PD)was assessed after multiple courses of treatment,and anti-CD19/20 CAR-T cell therapy was administered.The patient developed a high fever and chills,secondary dyspnea and hypotension at night on the day of infusion,and the inflammatory factors such as C-reactive protein(CRP)and interleukin-6(IL-6)increased sharply,suggesting the occurrence of cytokines release syndrome(CRS).After the patient was given symptomatic antipyretic,broad-spectrum anti-infection,tumor necrosis factor(TNF)antibody and three occasions of plasma exchange,the clinical manifestations of CRS gradually relieved.Three months after discharge,the patient was in complete response(CR).Conclusion CAR-T-associated CRS is a serious cellular immunotherapy-related toxicity that can result in multiple organ failure or even death in patients.Therapeutic plasma exchange may be a potential treatment for some patients with severe CRS.

关 键 词：血浆置换 细胞因子释放综合征 嵌合抗原受体T细胞 

分 类 号：R457.14[医药卫生—治疗学] R730.5[医药卫生—临床医学]