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

Abstract

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.

• Authors: Limin Xing, Yihao Wang, Hui Liu, Shan Gao, Qing Shao, Lanzhu Yue, Zhaoyun Liu, Huaquan Wang, Zonghong Shao, Rong Fu
• Journal: Frontiers in oncology (Front Oncol) Vol. 11 Pg. 798352 ( 2021) ISSN: 2234-943X [Print] Switzerland
• PMID: 35004324 (Publication Type: Case Reports)
• Copyright: Copyright © 2021 Xing, Wang, Liu, Gao, Shao, Yue, Liu, Wang, Shao and Fu.