Severe cases of local cytokine release syndrome (CRS); craniocervical edema soon after chimeric antigen T-cell (CAR-T) therapy
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...
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| Published in | Oxford Medical Case Reports Vol. 2025; no. 1; p. omae164 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Oxford University Press
01.01.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2053-8855 2053-8855 |
| DOI | 10.1093/omcr/omae164 |
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| Abstract | 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. |
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| AbstractList | 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.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. 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. |
| Author | Kanda, Junya Takaori-Kondo, Akifumi Nakamura, Naokazu Yamashita, Kouhei Mizumoto, Chisaki Jo, Tomoyasu Nishikori, Momoko Nagao, Miki Arai, Yasuyuki Kitawaki, Toshio |
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| References | Hay (2025011813275174500_ref4) 2018; 183 Inoue (2025011813275174500_ref6) 2023; 15 Crump (2025011813275174500_ref1) 2017; 130 Maude (2025011813275174500_ref3) 2018; 378 Nakanishi (2025011813275174500_ref7) 2023; 118 Ko (2025011813275174500_ref8) 2024; 25 Linera (2025011813275174500_ref9) 2023; 11 Luan (2025011813275174500_ref10) 2021; 12 Nakamura (2025011813275174500_ref11) 2023; 200 Frey (2025011813275174500_ref5) 2019; 25 Gisselbrecht (2025011813275174500_ref2) 2018; 182 Goto (2025011813275174500_ref12) 2023; 28 |
| References_xml | – volume: 15 start-page: e38905 year: 2023 ident: 2025011813275174500_ref6 article-title: Cervical local cytokine release syndrome following chimeric antigen receptor T-cell therapy in patients with relapsed or refractory diffuse large B-cell lymphoma publication-title: Cureus doi: 10.7759/cureus.38905 – volume: 183 start-page: 364 year: 2018 ident: 2025011813275174500_ref4 article-title: Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen receptor-modified (CAR-) T cell therapy publication-title: Br J Haematol doi: 10.1111/bjh.15644 – volume: 25 start-page: 399 year: 2024 ident: 2025011813275174500_ref8 article-title: CT demonstration of local cytokine-release syndrome involving the head and neck following chimeric antigen receptor T cell infusion therapy publication-title: Korean J Radiol doi: 10.3348/kjr.2023.1100 – volume: 11 start-page: e7281 year: 2023 ident: 2025011813275174500_ref9 article-title: Severe laryngeal edema after CAR-T cell treatment in a patient with multiple myeloma: a case report publication-title: Clin Case Rep doi: 10.1002/ccr3.7281 – volume: 118 start-page: 647 year: 2023 ident: 2025011813275174500_ref7 article-title: Laryngeal edema as a symptom of local cytokine release syndrome after BCMA-targeting CAR-T therapy for relapsed and refractory multiple myeloma publication-title: Int J Hematol doi: 10.1007/s12185-023-03633-8 – volume: 12 start-page: 707191 year: 2021 ident: 2025011813275174500_ref10 article-title: Case report: local cytokine release syndrome in an acute lymphoblastic Leukemia patient after treatment with chimeric antigen receptor T-cell therapy: a possible model, literature review and perspective publication-title: Front Immunol doi: 10.3389/fimmu.2021.707191 – volume: 182 start-page: 633 year: 2018 ident: 2025011813275174500_ref2 article-title: How I manage patients with relapsed/refractory diffuse large B cell lymphoma publication-title: Br J Haematol doi: 10.1111/bjh.15412 – volume: 130 start-page: 1800 year: 2017 ident: 2025011813275174500_ref1 article-title: Outcomes in refractory diffuae large B-cell lymphoma: results from the international SCHOLAR-1 study publication-title: Blood doi: 10.1182/blood-2017-03-769620 – volume: 25 start-page: e123 year: 2019 ident: 2025011813275174500_ref5 article-title: Cytokine release syndrome with chimeric antigen receptor T cell therapy publication-title: Biol Blood Marrow Transplant doi: 10.1016/j.bbmt.2018.12.756 – volume: 200 start-page: e1 year: 2023 ident: 2025011813275174500_ref11 article-title: Decreased serum phosphate levels are a useful biomarker to predict occurrence and severity of cytokine release syndrome in chimeric antigen receptor T-cell therapy publication-title: Br J Haematol doi: 10.1111/bjh.18504 – volume: 28 start-page: 816 year: 2023 ident: 2025011813275174500_ref12 article-title: Safety and efficacy of tisagenlecleucel in patients with relapsed or refractory B-cell lymphoma: the first real-world evidence in Japan publication-title: Int J Clin Oncol doi: 10.1007/s10147-023-02334-w – volume: 378 start-page: 439 year: 2018 ident: 2025011813275174500_ref3 article-title: Tisagenlecleucel in children and young adults with B-cell lymphoblastic Leukemia publication-title: N Engl J Med doi: 10.1056/NEJMoa1709866 |
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| Snippet | Craniocervical edema appears soon after chimeric antigen receptor T-cell (CAR-T) therapy in some cases. This phenomenon is often observed right after systemic... |
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| SubjectTerms | 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 |
| Title | Severe cases of local cytokine release syndrome (CRS); craniocervical edema soon after chimeric antigen T-cell (CAR-T) therapy |
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