Severe cases of local cytokine release syndrome (CRS); craniocervical edema soon after chimeric antigen T-cell (CAR-T) therapy

• Published in: Oxford Medical Case Reports Vol. 2025; no. 1; p. omae164
• Main Authors: Nakamura, Naokazu, Jo, Tomoyasu, Arai, Yasuyuki, Kitawaki, Toshio, Nishikori, Momoko, Mizumoto, Chisaki, Kanda, Junya, Yamashita, Kouhei, Nagao, Miki, Takaori-Kondo, Akifumi
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2025
• Subjects: Airway management; Antigens; Biomarkers; Case Report; Case reports; Chemotherapy; Conflicts of interest; Cytokine storm; Drug dosages; Edema; Epiglottis; Fever; Intubation; Lymphatic system; Lymphocytes; Lymphoma; Medical imaging; Medical laboratories; Medicine; Monoclonal antibodies; Neurotoxicity; Stem cells; Steroids; Transplants & implants; case report; chimeric antigen receptor T cell therapy; cytokine release syndrome
• ISSN: 2053-8855; 2053-8855
• DOI: 10.1093/omcr/omae164

Craniocervical edema appears soon after chimeric antigen receptor T-cell (CAR-T) therapy in some cases. This phenomenon is often observed right after systemic cytokine release syndrome (CRS), and it is called local CRS (L-CRS). In severe cases, L-CRS causes airway obstruction and asphyxia, but it is not yet well known among hematologists. In this report, we present mild and severe cases of L-CRS. Tocilizumab might have limited efficacy against L-CRS, and early administration of corticosteroids can be important. We hope that this case report raises awareness of L-CRS as an acute-onset adverse event after CAR-T therapy.