Pleural cavity cytokine release syndrome in CD19-directed chimeric antigen receptor-modified T cell therapy

RATIONALE Cytokine release syndrome (CRS) is a common and potentially fatal complication of CAR-T cell therapy. However, compartment CRS is relatively rare in hematological malignancies, as well as in solid tumors. The pathogenesis and prognosis of compartment CRS are unclear and there is no standardized treatment yet. In this case report, we will introduce a patient developing pleural cavity CRS after CART19s infusion. PATIENT CONCERNS A 28-year-old woman was admitted for evaluation of mediastinal mass. Her relevant examinations were comoleted. DIAGNOSES She was diagnosed as diffuse large B cell lymphoma (DLBCL, non-GCB type). INTERVENTIONS She received chemotherapies including 1 cycle of R-DAEPORCH, 1 cycle of R-CHOPE, 2 cycles of R-CHOP, and 4 cycles of R-GDP during the disease course. OUTCOMES The cytokine levels of hydrothorax were considerably high when serum cytokines were within normal range, with IL-6 at 1212.45 versus 5.69 pg/mL. qPCR analysis for CAR constructs showed 1,119,696 copies/μg DNA in hydrothorax and 522,227 copies/μg DNA in blood. LESSONS The results indicated that CART19 cells trafficked to the pleural cavity and interacted with the CD19-positive lymphoma cells directly, causing cytokine release in situ.