Unexpected neurologic complications following a novel lymphoma treatment ‘expected’ to give rise to neurologic toxicity

Chimeric antigen receptor (CAR) T-cell therapy is a novel and promising form of cellular immunotherapy using genetically engineered, tumour-specific autologous T cells. CD19-specific CAR T-cells have been shown to be very effective as a treatment for relapsed/refractory B-cell acute lymphoblastic le...

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Bibliographic Details
Published in:BMJ case reports 2019-11, Vol.12 (11), p.e229946
Main Authors: Kersten, Marie José, van Ettekoven, Cornelis N, Heijink, Dianne M
Format: Article
Language:English
Subjects:
Antigens
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Aphasia
Brain research
Cancer therapies
Case reports
Chemotherapy
Cyclophosphamide - therapeutic use
Cytokines
Diagnostic Errors
Doxorubicin - therapeutic use
Edema
Fever
haematology (drugs and medicines)
haematology (incl blood transfusion)
Headaches
Humans
immunological products and vaccines
Immunotherapy
Immunotherapy, Adoptive - methods
Lymphocytes
Lymphoma
Lymphoma, Large B-Cell, Diffuse - therapy
Magnetic Resonance Imaging
Male
Middle Aged
Neurotoxicity
Neurotoxicity Syndromes - diagnosis
Novel treatment (new drug/intervention
established drug/procedure in new situation)
Patients
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Prednisone - therapeutic use
Receptors, Antigen, T-Cell
Recurrence
Rituximab - therapeutic use
Sinus Thrombosis, Intracranial - diagnostic imaging
Sinuses
Stem cells
T-Lymphocytes - immunology
Thrombosis
Toxoplasmosis
Toxoplasmosis, Cerebral - diagnostic imaging
Transplants & implants
Vincristine - therapeutic use
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Summary:Chimeric antigen receptor (CAR) T-cell therapy is a novel and promising form of cellular immunotherapy using genetically engineered, tumour-specific autologous T cells. CD19-specific CAR T-cells have been shown to be very effective as a treatment for relapsed/refractory B-cell acute lymphoblastic leukaemia and aggressive B-cell non-Hodgkin’s lymphoma. ICANS (immune effector cell-associated neurotoxicity syndrome) is one of the most frequently occurring toxicities of CAR T-cell treatment. We describe two cases of patients with neurologic symptoms following CAR T-cell infusion who were suspected to have ICANS, but in fact had cerebral toxoplasmosis and venous sinus thrombosis respectively. The focus on CRS and ICANS after CAR T-cell infusion may lead to less vigilance to the ‘normal’ threats faced by intensively pretreated patients with lymphoma such as infections and thrombosis. Both cases underscore the importance of a broad and thorough examination of patients if they experience neurologic symptoms after CAR T-cell treatment.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-229946