CAR-T related hemophagocytic lymphohistiocytosis in multiple myeloma: A case report and literature review
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摘要: 目的探讨嵌合抗原受体T细胞(CAR-T)治疗合并噬血细胞综合征(HLH)的发病机制、临床特征及诊疗。方法回顾性分析1例复发难治性多发性骨髓瘤患者CAR-T治疗发生HLH的临床表现、诊疗经过及后期随访, 并结合相关文献报道, 分析CAR-T治疗的相关毒副反应及诊疗方案。结果该例患者CAR-T输注后第2天即发生1级细胞因子释放综合征(CRS), 输注后第35天出现3级CRS, 且合并HLH, 给予甲泼尼龙及托珠单抗治疗后缓解, 现随访15个月余, 原发病维持严格意义的完全缓解。结论CAR-T相关HLH发生率虽然极低, 但临床医师应该保持警惕, 并延长观察时间, 其治疗方案可参考HLH-2004方案Abstract: ObjectiveTo investigate the pathogenesis, clinical features, diagnosis and treatment of hemophagocytic lymphohistiocytosis(HLH) associated with chimeric antigen receptor T cell(CAR-T) therapy.MethodsThe clinical manifestations, diagnosis, treatment and follow-up of a relapsed and refractory multiple myeloma patient who underwent CAR-T associated HLH were retrospectively analyzed, and the related toxic and adverse events of CAR-T therapy and treatment plan were analyzed in combination with relevant literature.ResultsCytokine release syndrome(CRS) occurred in the patient +2 d after CAR-T infusion, and grade 3 CRS occurred +35 d later with HLH, which was relieved after methylprednisolone and tozizumab treatment. The patient is now followed up for more than 15 months, and the primary disease remains stringent complete response.ConclusionAlthough the incidence of CAR-T associated HLH is extremely low, clinicians should remain vigilant and extend the observation period, and treatment options can be referred to HLH-2004.
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