Cervical Edema Extending to the Larynx as Local Cytokine Release Syndrome Following Chimeric Antigen Receptor T-Cell Therapy in a Boy with Refractory Acute Lymphoblastic Leukemia

Haruko Shima, Takumi Kurosawa, Hiroyuki Oikawa, Hisato Kobayashi, Emiri Nishi, Fumito Yamazaki, Kentaro Tomita, Hiroyuki Shimada

Research output: Contribution to journalArticlepeer-review

Abstract

Cytokine release syndrome (CRS) is one of the major acute complications caused by massive cytokine release after chimeric antigen receptor (CAR) T-cell therapy. Patients with tumor masses were considered at high risk of local CRS induced by the expansion of CAR T cells in the tumor masses. However, even patients without any tumor burden around the neck are at risk of developing cervical edema as local CRS, which can lead to life-threatening airway obstruction. Here, we present the case of a 15-year-old boy who developed cervical edema as a local CRS after CAR T-cell therapy for refractory acute lymphoblastic leukemia. Despite administration of tocilizumab and methylprednisolone for persistent fever as a symptom of systemic CRS after CAR T-cell therapy, cervical edema occurred and extended to the larynx, resulting in dysphagia and hoarseness. Dexamethasone was remarkably effective, and the laryngeal symptoms resolved within a few hours. Local cytokine syndrome showed exacerbation with tocilizumab but exhibited considerable improvement with dexamethasone administration.

Original languageEnglish
Pages (from-to)257-262
Number of pages6
JournalCase Reports in Oncology
DOIs
Publication statusAccepted/In press - 2022

Keywords

  • Chimeric antigen receptor T-cell therapy
  • Cytokine release syndrome
  • Laryngeal edema

ASJC Scopus subject areas

  • Oncology

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