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2015 ; 23
(9
): 1541-50
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Case Report of a Fatal Serious Adverse Event Upon Administration of T Cells
Transduced With a MART-1-specific T-cell Receptor
#MMPMID25896248
van den Berg JH
; Gomez-Eerland R
; van de Wiel B
; Hulshoff L
; van den Broek D
; Bins A
; Tan HL
; Harper JV
; Hassan NJ
; Jakobsen BK
; Jorritsma A
; Blank CU
; Schumacher TN
; Haanen JB
Mol Ther
2015[Sep]; 23
(9
): 1541-50
PMID25896248
show ga
Here, we describe a fatal serious adverse event observed in a patient infused
with autologous T-cell receptor (TCR) transduced T cells. This TCR, originally
obtained from a melanoma patient, recognizes the well-described HLA-A*0201
restricted 26-35 epitope of MART-1, and was not affinity enhanced. Patient 1 with
metastatic melanoma experienced a cerebral hemorrhage, epileptic seizures, and a
witnessed cardiac arrest 6 days after cell infusion. Three days later, the
patient died from multiple organ failure and irreversible neurologic damage.
After T-cell infusion, levels of IL-6, IFN-?, C-reactive protein (CRP), and
procalcitonin increased to extreme levels, indicative of a cytokine release
syndrome or T-cell-mediated inflammatory response. Infused T cells could be
recovered from blood, broncho-alveolar lavage, ascites, and after autopsy from
tumor sites and heart tissue. High levels of NT-proBNP indicate semi-acute heart
failure. No cross reactivity of the modified T cells toward a beating
cardiomyocyte culture was observed. Together, these observations suggest that
high levels of inflammatory cytokines alone or in combination with semi-acute
heart failure and epileptic seizure may have contributed substantially to the
occurrence of the acute and lethal event. Protocol modifications to limit the
risk of T-cell activation-induced toxicity are discussed.
|Adult
[MESH]
|Cell- and Tissue-Based Therapy/*adverse effects/methods
[MESH]