[Successful management of cardiac arrest due to cytokine release syndrome following chimeric antigen receptor T-cell therapy for multiple myeloma].

Abstract

A 58-year-old woman received chimeric antigen receptor T-cell (CAR-T) therapy for triple-class refractory multiple myeloma. Following CAR-T infusion, she developed severe cytokine release syndrome (CRS) and was promptly admitted to the intensive care unit (ICU). Subsequently, she developed immune effector cell-associated neurotoxicity syndrome (ICANS), and then progressed to cardiac arrest. This life-threatening complication was successfully managed with intensive multidisciplinary treatment including mechanical ventilation, vasopressor support, and continuous renal replacement therapy. The patient's high tumor burden at the time of CAR-T infusion likely contributed to the severity of CRS and ICANS. Early intervention with dexamethasone and steroid pulse therapy, along with timely ICU admission, played a pivotal role in the success of treatment. This case highlights the importance of identifying high tumor burden as a risk factor for severe CAR-T-related complications and working closely with medical teams.