Extracorporeal blood purification in the management of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor T cell therapy: a case report

Chimeric antigen receptor T-cell (CAR-T) therapy is associated with potentially severe toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). We report a case of a 32-year-old man with refractory diffuse large B-cell lymphoma who developed severe ICANS after axicabtagene ciloleucel infusion despite standard treatment with corticosteroids, tocilizumab, anakinra, and supportive therapy. Because of rapid clinical deterioration, extracorporeal blood purification with CytoSorb was initiated. The treatment was followed by rapid neurological and hemodynamic improvement, reduction of inflammatory markers, and transfer from the intensive care unit to the hematology ward. CAR-T cell expansion, monitored by droplet digital PCR, was preserved after cytokine adsorption. This case suggests that extracorporeal blood purification may be a feasible rescue strategy for severe CAR-T-related neurotoxicity without compromising CAR-T cell activity.