Cytokine release syndrome (CRS) is the most common toxicity induced by
chimeric antigen receptor (CAR) T cell therapy. At present,
anti-IL-6 agents including
tocilizumab and
siltuximab have been applied in the treatment of CRS. However,
tocilizumab and
siltuximab are expensive and some patients fail to respond to anti-IL-6
therapy, which urges the need for new drugs. In clinical practice, we found some patients with
multiple myeloma developed markedly increased levels of
tumor necrosis factor (TNF)- α during the CRS period after anti-
BCMA CAR T cell infusion. Here we present the successful use of TNF-α inhibitor (
etanercept) to cure CRS in three patients. The introduction of
etanercept did not alter patients' response to CAR T cell therapy and no adverse event was observed directly related to the administration of
etanercept. Furthermore, in vitro experiments confirmed that
etanercept did not affect the proliferation and effector function of CAR T cells. Our results indicate that
etanercept could be considered as a treatment option for CRS in patients with significantly elevated TNF-α levels.