Thrombotic microangiopathy following chimeric antigen receptor T-cell therapy.

Matthew S Wu, Abbal Koirala
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引用次数: 2

Abstract

Introduction: Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia and is associated with a variety of conditions and following hematopoietic stem cell transplantation. Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapeutic approach using genetically modified autologous T cells. CAR-T therapy has been linked with injuries to vascular endothelium, but a direct association between CAR-T and TMA has not been reported.

Case reports: Two cases of TMAs following CAR-T treatment are reported here. In each case, clinical evidence of kidney injury, thrombocytopenia, and hemolytic anemia became apparent 2 - 3 months following CAR-T infusion. We describe the clinical course, management, and outcome of these experiences.

Discussion/conclusion: CAR-T cell therapy-associated TMA (CAR-T TMA) appear to be an entity that shares overlapping clinical features with transplant-associated TMA (TA-TMA). Based on our preliminary clinical observations, we discuss the best clinical diagnosis/classification criteria, underlying pathophysiology, and the implication of the apparently self-limiting course. With increasing use of CAR-T cell treatment in hematologic malignancies, systematic studies will be necessary to improve management of CAR-T TMA.

嵌合抗原受体t细胞治疗后的血栓性微血管病。
简介:血栓性微血管病(TMA)以微血管病性溶血性贫血为特征,与多种情况和造血干细胞移植相关。嵌合抗原受体T细胞(CAR-T)疗法是一种利用基因修饰的自体T细胞进行免疫治疗的新方法。CAR-T治疗与血管内皮损伤有关,但CAR-T和TMA之间的直接联系尚未报道。病例报告:本文报告了CAR-T治疗后的两例TMAs。在每个病例中,CAR-T输注后2 - 3个月,肾损伤、血小板减少和溶血性贫血的临床证据变得明显。我们描述这些经验的临床过程、管理和结果。讨论/结论:CAR-T细胞治疗相关TMA (CAR-T TMA)似乎是与移植相关TMA (TA-TMA)具有重叠临床特征的实体。基于我们初步的临床观察,我们讨论了最佳的临床诊断/分类标准,潜在的病理生理学,以及明显的自我限制过程的含义。随着CAR-T细胞治疗在血液系统恶性肿瘤中的应用越来越多,系统的研究将有必要改善CAR-T TMA的管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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