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Chimeric antigen receptor T-cell neuropsychiatric toxicity in acute lymphoblastic leukemia

Published online by Cambridge University Press:  04 January 2017

Vasthie Prudent  and
William S. Breitbart
Vasthie Prudent*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine Sylvester Cancer Center, Miami, Florida
William S. Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Vasthie Prudent, 1475 NW 12th Avenue, University of Miami Miller School of Medicine, Suite C021, Locator code D21, Miami, Florida 33136. E-mail: vasthieprudent.md@gmail.com.
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Abstract

Chimeric antigen receptor T cells are used in the treatment of B-cell leukemias. Common chimeric antigen receptor T-cell toxicities can range from mild flu-like symptoms, such as fever and myalgia, to a more striking neuropsychiatric toxicity that can present as discrete neurological symptoms and delirium. We report here two cases of chimeric antigen receptor T-cell neuropsychiatric toxicity, one who presented as a mild delirium and aphasia that resolved without intervention, and one who presented with delirium, seizures, and respiratory insufficiency requiring intensive treatment. The current literature on the treatment and proposed mechanisms of this clinically challenging chimeric antigen receptor T-cell complication is also presented.

Keywords

Chimeric antigen receptorNeurotoxicityCytokine release syndromeAcute lymphoblastic leukemia
Type
Case Report
Information
Palliative & Supportive Care , Volume 15 , Issue 4 , August 2017 , pp. 499 - 503
Copyright
Copyright © Cambridge University Press 2017 

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