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Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy

Chimeric antigen receptor T (CAR-T) cells show good efficacy in the treatment of relapsed and refractory B-cell tumors, such as acute B-cell leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL). The main toxicities of CAR-T include cytokine release syndrome, immune effector cell-associated neuro...

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Autores principales: Xing, Limin, Wang, Yihao, Liu, Hui, Gao, Shan, Shao, Qing, Yue, Lanzhu, Liu, Zhaoyun, Wang, Huaquan, Shao, Zonghong, Fu, Rong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733571/
https://www.ncbi.nlm.nih.gov/pubmed/35004324
http://dx.doi.org/10.3389/fonc.2021.798352
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author Xing, Limin
Wang, Yihao
Liu, Hui
Gao, Shan
Shao, Qing
Yue, Lanzhu
Liu, Zhaoyun
Wang, Huaquan
Shao, Zonghong
Fu, Rong
author_facet Xing, Limin
Wang, Yihao
Liu, Hui
Gao, Shan
Shao, Qing
Yue, Lanzhu
Liu, Zhaoyun
Wang, Huaquan
Shao, Zonghong
Fu, Rong
author_sort Xing, Limin
collection PubMed
description Chimeric antigen receptor T (CAR-T) cells show good efficacy in the treatment of relapsed and refractory B-cell tumors, such as acute B-cell leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL). The main toxicities of CAR-T include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia, and severe infection. It is still very difficult for CAR-T to kill tumor cells to the maximum extent and avoid damaging normal organs. Here, we report a case of DLBCL with persistent grade 4 thrombocytopenia and severe platelet transfusion dependence treated with CD19 CAR-T cells. We used sirolimus to inhibit the sustained activation of CAR-T cells and restore normal bone marrow hematopoiesis and peripheral blood cells. Moreover, sirolimus treatment did not affect the short-term efficacy of CAR-T cells, and DLBCL was in complete remission at the end of follow-up. In conclusion, sirolimus can represent a new strategy for the management of CAR-T cell therapy-related toxicity, including but not limited to hematotoxicity. However, further controlled clinical studies are required to confirm these findings.
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spelling pubmed-87335712022-01-07 Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy Xing, Limin Wang, Yihao Liu, Hui Gao, Shan Shao, Qing Yue, Lanzhu Liu, Zhaoyun Wang, Huaquan Shao, Zonghong Fu, Rong Front Oncol Oncology Chimeric antigen receptor T (CAR-T) cells show good efficacy in the treatment of relapsed and refractory B-cell tumors, such as acute B-cell leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL). The main toxicities of CAR-T include cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia, and severe infection. It is still very difficult for CAR-T to kill tumor cells to the maximum extent and avoid damaging normal organs. Here, we report a case of DLBCL with persistent grade 4 thrombocytopenia and severe platelet transfusion dependence treated with CD19 CAR-T cells. We used sirolimus to inhibit the sustained activation of CAR-T cells and restore normal bone marrow hematopoiesis and peripheral blood cells. Moreover, sirolimus treatment did not affect the short-term efficacy of CAR-T cells, and DLBCL was in complete remission at the end of follow-up. In conclusion, sirolimus can represent a new strategy for the management of CAR-T cell therapy-related toxicity, including but not limited to hematotoxicity. However, further controlled clinical studies are required to confirm these findings. Frontiers Media S.A. 2021-12-23 /pmc/articles/PMC8733571/ /pubmed/35004324 http://dx.doi.org/10.3389/fonc.2021.798352 Text en Copyright © 2021 Xing, Wang, Liu, Gao, Shao, Yue, Liu, Wang, Shao and Fu https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Xing, Limin
Wang, Yihao
Liu, Hui
Gao, Shan
Shao, Qing
Yue, Lanzhu
Liu, Zhaoyun
Wang, Huaquan
Shao, Zonghong
Fu, Rong
Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title_full Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title_fullStr Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title_full_unstemmed Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title_short Case Report: Sirolimus Alleviates Persistent Cytopenia After CD19 CAR-T-Cell Therapy
title_sort case report: sirolimus alleviates persistent cytopenia after cd19 car-t-cell therapy
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8733571/
https://www.ncbi.nlm.nih.gov/pubmed/35004324
http://dx.doi.org/10.3389/fonc.2021.798352
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