Article Text

Download PDFPDF
Case report
Unexpected neurologic complications following a novel lymphoma treatment ‘expected’ to give rise to neurologic toxicity
  1. Marie José Kersten1,
  2. Cornelis N van Ettekoven2 and
  3. Dianne M Heijink3
  1. 1 Department of Haematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
  2. 2 Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  3. 3 Department of Haematology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Professor Marie José Kersten, M.J.Kersten{at}amsterdamumc.nl

Abstract

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.

  • haematology (drugs and medicines)
  • immunological products and vaccines
  • haematology (incl blood transfusion)
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors MJK: planned the case study. All authors treated the patients and acquired and interpreted the data and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MJ Kersten has received travel support and honoraria for attending advisory boards and presentations for Kite/Gilead and Novartis. The other authors declare no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.