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Challenging Case @IDweek2019
63M B cell lymphoma
RCHOP, RICE —> CD19-CAR-T
ACV, Levo, Fluco Prophy
SIRS —> cytokine release syndrome
Rx tocilizumab —> anakinra
Mental status change —> CART-related encephalopathy
Rx: dexamethasone
Now coma / anisocoria
MRI / path (photo)
63M B cell lymphoma
RCHOP, RICE —> CD19-CAR-T
ACV, Levo, Fluco Prophy
SIRS —> cytokine release syndrome
Rx tocilizumab —> anakinra
Mental status change —> CART-related encephalopathy
Rx: dexamethasone
Now coma / anisocoria
MRI / path (photo)
Presented by Dr Pearlie Chong @UTSWNews at @IDWeek2019 what is the diagnosis of this neurologic complication following CD19-targeted CAR T cell Rx, followed by use of tocilizumab, anakinra and dexamethasone to manage cytokine release and encephalopathy syndrome?
Case diagnosis: cerebral angioinvasive #mucormycosis due to #Rhizopus
CD19-targeted CAR-T #immunotherapy for B cell cancers —> #lymphodepletion
Other immunodeficiencies:
1. conditioning Rx
2. hypogammaglobulinemia
3. IL-6 deficiency (tocilizumab)
4. IL-1 inhibition (anakinra)
CD19-targeted CAR-T #immunotherapy for B cell cancers —> #lymphodepletion
Other immunodeficiencies:
1. conditioning Rx
2. hypogammaglobulinemia
3. IL-6 deficiency (tocilizumab)
4. IL-1 inhibition (anakinra)
