Abstract:

Objective To analyze the clinical features of severe cytokine release syndrome (sCRS) in children with relapsed B lineage acute lymphoblastic leukemia (B-ALL) treated by CAR-T cell therapy, and to summarize their treatment methods. Methods The clinical data of 14 cases of CAR-T cell therapy relapsed B-ALL children admitted to the intensive care unit from January 2019 to June 2020 were collected, and retrospectively analyzed. Results After CAR-T cell infusion, nine cases developed sCRS, eleven children developed hemodynamic instability, five cases required mechanical ventilation, ten cases had neurological symptoms, and seven cases had liver damage. All 14 patients were treated with tocilizumab, some of them were given glucocorticoids, and five patients were treated with continuous blood purification. Three patients died, and eleven patients recovered within two weeks. Conclusion CRS is a common toxic reaction after CAR-T cell infusion, which can cause multiple organ dysfunction. The severity of CRS was positively correlated with the levels of cytokines IL-6 and IFN-γ. Tocilizumab and corticosteroids are the main treatments, and the blood purification can also be used as a special treatment for CRS.

Key words: CAR-T cell therapy, acute lymphoblastic leukemia, cytokine release syndrome, blood purification, child