Continuous renal replacement therapy in cytokine release syndrome following immunotherapy or cellular therapies?
Continuous renal replacement therapy in cytokine release syndrome following immunotherapy or cellular therapies?
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DOI：
10.1136/jitc-2020-000742
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发表时间：
2020-01-01
影响因子：
10.9
通讯作者：
Tomuleasa, Ciprian
中科院分区：
文献类型：
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作者：
Constantinescu, Catalin;Pasca, Sergiu;Tomuleasa, Ciprian
近年来，越来越多的新药在肿瘤学和血液学领域获得批准。然而，药理学的进步伴随着各种副作用，其中细胞因子释放综合征（CRS）是一些免疫疗法的潜在并发症，如果不进行相应的诊断和治疗，可能导致多器官衰竭。 CRS 通常发生在导致 T 细胞高度活化的疗法中，例如嵌合抗原受体 T 细胞或双特异性 T 细胞接合抗体。反过来，这会导致促炎状态，进而导致器官损伤。为了更好地管理 CRS，需要特定的疗法或重新调整已知在类似情况下有用的策略。目前针对 CRS 的治疗策略以抗细胞因子定向疗法和皮质类固醇为代表。基于其病理生理学以及 CRS 与脓毒症和脓毒性休克的相似性，以及脓毒症开始连续性肾脏替代治疗 (CRRT) 的原则，我们提出在所有其他方法均未能控制临床显着表现的情况下使用 CRRT 治疗作为 CRS 辅助治疗的基本原理。
Recently, an increasing number of novel drugs were approved in oncology and hematology. Nevertheless, pharmacology progress comes with a variety of side effects, of which cytokine release syndrome (CRS) is a potential complication of some immunotherapies that can lead to multiorgan failure if not diagnosed and treated accordingly. CRS generally occurs with therapies that lead to highly activated T cells, like chimeric antigen receptor T cells or in the case of bispecific T-cell engaging antibodies. This, in turn, leads to a proinflammatory state with subsequent organ damage. To better manage CRS there is a need for specific therapies or to repurpose strategies that are already known to be useful in similar situations. Current management strategies for CRS are represented by anticytokine directed therapies and corticosteroids. Based on its pathophysiology and the resemblance of CRS to sepsis and septic shock, as well as based on the principles of initiation of continuous renal replacement therapy (CRRT) in sepsis, we propose the rationale of using CRRT therapy as an adjunct treatment in CRS where all the other approaches have failed in controlling the clinically significant manifestations.