Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2022; 10(26): 9398-9403
Published online Sep 16, 2022. doi: 10.12998/wjcc.v10.i26.9398
Cytokine release syndrome complicated with rhabdomyolysis after chimeric antigen receptor T-cell therapy: A case report
Lan Zhang, Wei Chen, Xiao-Min Wang, Shu-Qing Zhang
Lan Zhang, Wei Chen, Xiao-Min Wang, Shu-Qing Zhang, Department of Hematology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Zhang L, Wang XM, Zhang SQ are responsible for the treatment of patient; Zhang L analyzed the data and wrote the manuscript; Chen W contributed coordination and manuscript review; all authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lan Zhang, Doctor, PhD, Assistant Professor, Department of Hematology, The First Hospital of Shanxi Medical University, No. 89 Xinjian Road, Taiyuan 030001, Shanxi Province, China. qiqi994@sina.com
Received: April 14, 2022
Peer-review started: April 14, 2022
First decision: June 7, 2022
Revised: June 20, 2022
Accepted: August 6, 2022
Article in press: August 6, 2022
Published online: September 16, 2022
Processing time: 140 Days and 18.4 Hours
Abstract
BACKGROUND

Chimeric antigen receptor T-Cell (CAR-T) therapy is an effective new treatment for hematologic malignancies. Cytokine release syndrome (CRS) and neurologic toxicity are main toxicities. CRS-induced rhabdomyolysis (RM) followed by CAR-T therapy treatment has not been previously reported.

CASE SUMMARY

We report a case of a 22-year-old woman with relapsed acute lymphoblastic leukemia obtained sequential cluster of differentiation (CD) 19 and CD22 CAR-T infusion. This patient experienced grade 3 CRS with RM, mild hypotension requiring intravenous fluids, and mild hypoxia and was managed effectively with the IL-6 receptor antagonist tocilizumab. This patient had no signs of immune effector cell-associated neurologic syndrome. Restaging scans 30 d postCAR-T therapy demonstrated a complete remission, and the symptoms of muscle weakness improved through rehabilitation.

CONCLUSION

Myalgia is an easily overlooked symptom of severe CRS after CAR-T therapy. It is necessary to monitor myoglobin levels when a patient presents with symptoms of myalgia or acute renal insufficiency.

Keywords: Cytokine release syndrome; Rhabdomyolysis; Chimeric antigen receptor-T cell therapy; Relapsed acute lymphoblastic leukemia; Case report

Core Tip: Cytokine release syndrome-induced rhabdomyolysis followed by chimeric antigen receptor-T (CAR-T) therapy treatment has not been previously reported. We report a case of a 22-year-old woman with relapsed acute lymphoblastic leukemia obtained sequential cluster of differentiation (CD) 19 and CD22 CAR-T cells infusion. This patient experienced grade 3 cytokine release syndrome with RM, mild hypotension requiring intravenous fluids, and mild hypoxia and was managed effectively with the interleukin-6 receptor antagonist tocilizumab. This patient had no signs of immune effector cell-associated neurologic syndrome. Restaging scans 30 d post CAR-T therapy demonstrated a complete remission, and the symptoms of muscle weakness improved through rehabilitation. Therefore, it is necessary to monitor myoglobin levels when a patient presents with symptoms of myalgia.