TY - JOUR
T1 - Eosinophilic Pleocytosis in the Cerebrospinal Fluid following CAR-T Cell Therapy for Central Nervous System Lymphoma
T2 - A Case for Warning?
AU - Ata, Mayasa Abu
AU - Henig, Israel
AU - Yehudai-Ofir, Dana
AU - Tzoran, Inna
AU - Ringelstein-Harlev, Shimrit
AU - Inbar, Tsofia
AU - Slouzkey, Ilana
AU - Karmona Fintuch, Michal
AU - Stern, Anat
AU - Stanevsky, Olesya
AU - Weiler-Sagie, Michal
AU - Zohar, Yaniv
AU - Livneh, Ido
AU - Merhav, Goni
AU - Eran, Ayelet
AU - Zuckerman, Tsila
AU - Katz, Ofrat Beyar
N1 - Publisher Copyright:
© 2024 S. Karger AG, Basel.
PY - 2024
Y1 - 2024
N2 - Introduction: Chimeric antigen receptor T (CAR-T) cell therapy, emerging as an efficient treatment option for patients with secondary central nervous system (CNS) lymphoma, is frequently complicated with immune effector cellassociated neurotoxicity syndrome (ICANS). Case Presentation: We report a case of a 64-year-old woman with transformed follicular lymphoma, developing highgrade ICANS with eosinophilic pleocytosis following thirdline therapy with CAR-T cells (tisagenlecleucel). During bridging therapy, she declined neurologically and was diagnosed with secondary CNS lymphoma. She received methotrexate-cytarabine-thiotepa-rituximab regimen with clinical and radiological improvement. Post-CAR-T cell infusion she developed cytokine release syndrome grade II and ICANS grade III. Given the lack of response to steroids, anakinra was initiated with complete ICANS resolution. Cerebrospinal fluid (CSF) analysis, performed only on day +10 due to thrombocytopenia, revealed eosinophils, while infections were excluded. Conclusion: This report emphasizes the importance of CSF analysis in individuals with CART-related neurotoxicity for elucidating the role of specific immune cells in such complications.
AB - Introduction: Chimeric antigen receptor T (CAR-T) cell therapy, emerging as an efficient treatment option for patients with secondary central nervous system (CNS) lymphoma, is frequently complicated with immune effector cellassociated neurotoxicity syndrome (ICANS). Case Presentation: We report a case of a 64-year-old woman with transformed follicular lymphoma, developing highgrade ICANS with eosinophilic pleocytosis following thirdline therapy with CAR-T cells (tisagenlecleucel). During bridging therapy, she declined neurologically and was diagnosed with secondary CNS lymphoma. She received methotrexate-cytarabine-thiotepa-rituximab regimen with clinical and radiological improvement. Post-CAR-T cell infusion she developed cytokine release syndrome grade II and ICANS grade III. Given the lack of response to steroids, anakinra was initiated with complete ICANS resolution. Cerebrospinal fluid (CSF) analysis, performed only on day +10 due to thrombocytopenia, revealed eosinophils, while infections were excluded. Conclusion: This report emphasizes the importance of CSF analysis in individuals with CART-related neurotoxicity for elucidating the role of specific immune cells in such complications.
KW - Central nervous system lymphoma
KW - Cerebrospinal fluid analysis
KW - Diffuse large B-cell lymphoma
KW - Eosinophilic pleocytosis
KW - Immune effector cell-associated neurotoxicity syndrome
UR - http://www.scopus.com/inward/record.url?scp=85196860975&partnerID=8YFLogxK
U2 - 10.1159/000539354
DO - 10.1159/000539354
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C2 - 38781944
AN - SCOPUS:85196860975
SN - 0001-5792
JO - Acta Haematologica
JF - Acta Haematologica
ER -