Novel Treatment Modality for Chimeric Antigen Receptor T-cell Therapy Complications: A Case Report

TL;DR

This case report describes a novel treatment approach using anakinra to manage complications from CAR T-cell therapy in a leukemia patient.

Contribution

The paper introduces the use of anakinra as an adjunct to standard treatment for CAR T-cell therapy complications.

Findings

The patient developed CRS and ICANS following blinatumomab CAR-T cell therapy.

Anakinra was added to the treatment regimen to manage ICANS effectively.

The case highlights the potential for improved management of CAR T-cell therapy adverse effects.

Abstract

Immune cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) are both common adverse effects of chimeric antigen receptor (CAR) T-cell therapy. Blinatumomab is a commonly used CAR T-cell treatment in patients with B-cell acute lymphoblastic leukemia (B-ALL). Our patient presented with an extensive past medical history, including refractory B-ALL, and developed CRS and ICANS following treatment with blinatumomab CAR-T cell therapy. Early clinical detection of ICANS, monitoring using immune effector cell encephalopathy scores, following the appropriate protocol for ICANS grade, and adding anakinra (IL-1 receptor antagonist) were crucial steps in managing his condition. The approach to managing and monitoring this patient was unique in that we added anakinra to the standard treatment regimen. With this report, we emphasize the need for further research regarding CAR T-cell therapeutic regimens and how to decrease the morbidity and mortality of its adverse effects.

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