Open AccessUsing JAK inhibitor to treat cytokine release syndrome developed after chimeric antigen receptor T cell therapy for patients with refractory acute lymphoblastic leukemia
Author(s) -
Fu Ming Zi,
Long Long Ye,
Zheng Ji,
Jing Cheng,
Qing Ming Wang
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025786
Subject(s) - medicine , tocilizumab , cytokine release syndrome , chimeric antigen receptor , ruxolitinib , refractory (planetary science) , methylprednisolone , immunology , adverse effect , gastroenterology , immunotherapy , bone marrow , cancer , physics , disease , astrobiology , myelofibrosis
Rationale: Significant concerns about the adverse effects following chimeric antigen receptor T cell (CAR-T) therapy are still remained including cytokine release syndrome (CRS). In rare circumstances, CRS may be refractory to tocilizumab and/or corticosteroids, a new treatment is needed for the management of CRS. Patient concerns: We present a case of a 20-year-old male patient with acute lymphoblastic leukemia developed CRS after CD19/CD22 bispecific CAR-T treatment. Diagnosis: The patient was diagnosed with BCR-ABL(P210) positive B-ALL and developed CRS after CD19/CD22 bispecific CAR-T treatment. Interventions: Tocilizumab and methylprednisolone were administered, unfortunately the patient's symptoms of CRS were still not resolved. Another methylprednisolone and ruxolitinib were administered. Outcomes: The persistent fever and hypotension of this patient achieved a rapid clinical remission within hours after ruxolitinib administration. Lessons: Ruxolitinib can be used as an alternative therapeutic approach for severe and refractory CRS without impairing CAR-T amplification and anti-tumor effect.