Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report.

Abstract

RATIONALE:

Anti-CD19-targeted chimeric antigen receptor (CAR) T cell therapy is effective in treating relapsed/refractory diffuse large B-cell lymphoma (DLBCL). This therapy is associated with several side effects that can be life-threatening such as cytokine release syndrome (CRS). However, chylothorax associated with CRS after CAR-T therapy has not been reported.

PATIENT CONCERNS:

A 23-year-old male diagnosed with DLBCL relapsing after autologous peripheral blood stem cell transplantation was treated with anti-CD19-targeted CAR-T cell therapy. After CAR-T cell transfusion, he developed grade 3 CRS includes fever, dyspnea, tachycardia and hypotension. The symptoms of CRS persisted and chest plain film revealed bilateral pleural effusion.

DIAGNOSIS:

Chylothorax was confirmed by the pleural effusion analysis that triglyceride level was 1061 mg/dL. Bacterial and fungal culture of pleural fluid reported no pathogen was detected. Cytological examination of pleural effusion revealed no malignant cells.

INTERVENTIONS:

The chylothorax resolved after treatment with intravenous administration of tocilizumab.

OUTCOMES:

On 30-day follow-up, the patient was in stable clinical condition with complete remission of DLBCL on whole-body positron emission tomography scan.

LESSONS:

We reported a rare case of CAR-T associated chylothorax in a patient with relapsed and refractory DLBCL. Grade 3 CRS with high interleukin-6 level was presented in our patient. The symptoms of CRS were improved with tocilizumab treatment and the chylothorax resolved later on. It is suggested that high interleukin-6 releases might induce chyle leakage resulting from activations of endothelium and coagulation. Our finding highlights the occurrence of chylothorax during the course of CAR-T cell therapy and the importance of proper monitoring and prompt management of this life-threatening side effect.

• Authors: Hsin-Hui Chen, Cheng-Yi Kuo, Ching-Liang Ho, Yeu-Chin Chen
• Journal: Medicine (Medicine (Baltimore)) Vol. 102 Issue 41 Pg. e35432 (Oct 13 2023) ISSN: 1536-5964 [Electronic] United States
• PMID: 37832125 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Receptors, Chimeric Antigen
• Receptors, Antigen, T-Cell
• Interleukin-6
• Antigens, CD19

Topics

• Male
• Humans
• Young Adult
• Adult
• Receptors, Chimeric Antigen (therapeutic use)
• Receptors, Antigen, T-Cell
• Chylothorax (etiology, therapy)
• Interleukin-6 (therapeutic use)
• Neoplasm Recurrence, Local (drug therapy)
• Lymphoma, Large B-Cell, Diffuse (drug therapy)
• Immunotherapy, Adoptive (adverse effects, methods)
• Cytokine Release Syndrome (drug therapy)
• Antigens, CD19
• Peripheral Blood Stem Cell Transplantation
• Pleural Effusion (drug therapy)