Cerebral edema secondary to chimeric antigen receptor T cell immunotherapy
A 40 year old man with relapsed acute lymphoblastic leukemia received lymphodepleting chemotherapy followed by immunotherapy with autologous T cells expressing a chimeric antigen receptor (CAR) targeting CD19. Two days after infusion of CD19 CAR T cells, he developed fever refractory to acetaminophen; received a dose of the interleukin 6 receptor inhibitor, tocilizumab; and defervesced. Five days later, he had recurrent fever and rapid onset of mental status changes. Over the subsequent hours, he developed seizures and became obtunded. MRI revealed cerebral edema (figure, B) associated with his progressive and fulminant CAR T cell related encephalopathy syndrome, which was irreversible, and resulted in brain death.1,2
Neurology