Cytokine release syndrome complicated with rhabdomyolysis after chimeric antigen receptor T-cell therapy: A case report

Abstract

BACKGROUND Chimeric antigen receptor T-Cell (CAR-T) therapy is an effective new treatment for hematologic malignancies. Cytokine release syndrome (CRS) and neurologic toxicity are main toxicities. CRS-induced rhabdomyolysis (RM) followed by CAR-T therapy treatment has not been previously reported. CASE SUMMARY We report a case of a 22-year-old woman with relapsed acute lymphoblastic leukemia obtained sequential cluster of differentiation (CD) 19 and CD22 CAR-T infusion. This patient experienced grade 3 CRS with RM, mild hypotension requiring intravenous fluids, and mild hypoxia and was managed effectively with the IL-6 receptor antagonist tocilizumab. This patient had no signs of immune effector cell-associated neurologic syndrome. Restaging scans 30 d postCAR-T therapy demonstrated a complete remission, and the symptoms of muscle weakness improved through rehabilitation. CONCLUSION Myalgia is an easily overlooked symptom of severe CRS after CAR-T therapy. It is necessary to monitor myoglobin levels when a patient presents with symptoms of myalgia or acute renal insufficiency.

Rare Adverse Events of CAR T-Cell Therapy

“…A 22-year-old woman with R/R ALL and an extremely low body weight of 35 kg received sequential infusions of CD19 and CD22-targeted CAR T-cells. 37 On Days 2−3, she experienced a fever of 40.3 o C, irritability, photophobia, confusion, dizziness, headache, blurred vision and vomiting. On Day 7, the patient developed severe pain in both lower limbs and myoglobin and creatine kinase levels were significantly elevated, indicating rhabdomyolysis complication of grade 3 CRS.…”