Arthritis of huge joints proven as a uncommon scientific characteristic of cytokine launch syndrome after chimeric antigen receptor T cell remedy: A case report.
Medication (Baltimore). 2018 Apr;97(16):e0455
Authors: Wang LX, Chen X, Jia M, Wang S, Shen J
RATIONALE: Chimeric antigen receptor (CAR)-T cell remedy is a novel kind of remedy that’s being utilized in an rising variety of sufferers with acute lymphoblastic leukemia (ALL). Cytokine launch syndrome (CRS) is the most typical complication following CAR-T therapy, however the present understanding of the scientific manifestations and pathogenesis of CRS continues to be restricted.
PATIENT CONCERNS: A 34-year-old male affected person was recognized with ALL in June 2015. Full remission (CR) was achieved after induction chemotherapy. The affected person obtained eight cycles of consolidation chemotherapy to take care of CR. In Could 2017, the affected person had recurrent ALL. Induction chemotherapy was given once more, however with out remission. In October 2017, CAR-T cell remedy was given. On October 14, the affected person was pretreated with an FC routine (fludarabine phosphate 50?mg qd on days 1-Three; cyclophosphamide zero.four?g qd on days 1-Three). CAR-T cells had been infused on October 19 and October 20, with the variety of infused cells at 2?×?10/kg and 1?×?10/kg, respectively. On October 25, the affected person had a excessive fever, swelling, and ache within the giant joints of the limbs, and joint effusion.
DIAGNOSIS: This affected person was recognized with relapsed ALL, and he developed CRS after CAR-T remedy.
INTERVENTIONS: Tacilizumab (400?mg) was infused after CRS was recognized, and one other dose of tacilizumab (240?mg) was given 6 days later. The ache was additionally handled with an analgesic drug. Methylprednisolone (1?mg/kg) was given to deal with arthritis of the big joints.
OUTCOMES: The affected person’s temperature was again to regular inside 1?hour following the therapy of tacilizumab, however the ache within the giant joints was progressively aggravated. The joint swelling and ache had been clearly alleviated after the therapy of methylprednisolone, and the joint mobility was step by step recovered.
LESSONS: CRS after CAR-T remedy can manifest as a excessive fever with swelling and ache within the giant joints of the limbs, much like rheumatoid arthritis. Tocilizumab can decrease the physique temperature, but it surely has no important impact on arthritis. Glucocorticoids can quickly alleviate joint swelling and ache.
PMID: 29668614 [PubMed – in process]