Irreversible paraplegia due to transverse myelitis as a rare complication of CAR T-cell therapy in a patient with B-cell lymphoma.

Abstract

Purpose: To report a rare case of irreversible paraplegia due to transverse myelitis as a severe neurotoxic complication of chimeric antigen receptor (CAR) T-cell therapy.

Case description: A 45-year-old woman with primary mediastinal B-cell lymphoma received axicabtagene ciloleucel. She deve-loped Grade 4 neurotoxicity with seizures requiring intubation. Upon regaining consciousness, she presented with flaccid paralysis of the lower limbs, sensory loss, and sphincter dysfunction. Magnetic resonance imaging revealed longitudinally extensive spinal cord lesions. Despite treatment with corticosteroids, anakinra, and intravenous immunoglobulin, no neurological improvement was observed. One year after the therapy, the patient remained in complete remission from lymphoma but was wheelchair-dependent, with persistent paralysis and spinal cord atrophy.

Comment: This case highlights a rare and severe form of CAR T-cell-related neurotoxicity, manifesting as transverse myelitis in the absence of a marked inflammatory response. The refractory course and lack of standard treatment options underscore the need for greater awareness, reporting, and further research into atypical neurological complications of CAR T-cell therapy.