Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective measure for the treatment of hematological disease. With the progress and wide use of allo-HSCT, post-transplant central nervous system complications (CNSC) have gotten more and more attention because of its poor prognosi...
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Elsevier
2024-11-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024163876 |
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| author | Ruirui Gui Zhen Li Juan Wang Yingling Zu Binglei Zhang Juanjuan Zhao Yongping Song Jian Zhou |
| author_facet | Ruirui Gui Zhen Li Juan Wang Yingling Zu Binglei Zhang Juanjuan Zhao Yongping Song Jian Zhou |
| author_sort | Ruirui Gui |
| collection | DOAJ |
| description | Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective measure for the treatment of hematological disease. With the progress and wide use of allo-HSCT, post-transplant central nervous system complications (CNSC) have gotten more and more attention because of its poor prognosis and high mortality. Since there is no standard treatment for patients with immune-mediated CNSC currently, new treatments are needed to be developed urgently. Here, we attempted a novel therapy regimen of intrathecal tocilizumab injection in two pediatric patients with immune-mediated CNSC manifested as cytokine release syndrome (CRS) after haploidentical hematopoietic stem cell transplantation (halpo-HSCT). In the two patients, persistent seizure symptoms could not be resolved 7 h after intravenous tocilizumab, while the symptoms were controlled rapidly only 2 hours or 1 hour after the first intrathecal injection of tocilizumab. Moreover, the level of interleukin 6 in the cerebrospinal fluid returned to normal after the fifth intrathecal injection. Even more appealing, no acute or chronic adverse reactions were observed during injection and subsequent follow-up. In conclusion, intrathecal tocilizumab seems to be more rapid and effective than intravenous administration for immune-mediated CNSC manifested as CRS in haplo-HSCT recipients. We recommend this treatment modality for further investigation. |
| format | Article |
| id | doaj-art-3c193627567d4357958c6642b5f3b854 |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-3c193627567d4357958c6642b5f3b8542024-11-30T07:12:39ZengElsevierHeliyon2405-84402024-11-011022e40356Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reportsRuirui Gui0Zhen Li1Juan Wang2Yingling Zu3Binglei Zhang4Juanjuan Zhao5Yongping Song6Jian Zhou7Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, ChinaDepartment of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, ChinaDepartment of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, ChinaDepartment of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, ChinaDepartment of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaDepartment of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, China; Corresponding author. Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan, 450000, China.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective measure for the treatment of hematological disease. With the progress and wide use of allo-HSCT, post-transplant central nervous system complications (CNSC) have gotten more and more attention because of its poor prognosis and high mortality. Since there is no standard treatment for patients with immune-mediated CNSC currently, new treatments are needed to be developed urgently. Here, we attempted a novel therapy regimen of intrathecal tocilizumab injection in two pediatric patients with immune-mediated CNSC manifested as cytokine release syndrome (CRS) after haploidentical hematopoietic stem cell transplantation (halpo-HSCT). In the two patients, persistent seizure symptoms could not be resolved 7 h after intravenous tocilizumab, while the symptoms were controlled rapidly only 2 hours or 1 hour after the first intrathecal injection of tocilizumab. Moreover, the level of interleukin 6 in the cerebrospinal fluid returned to normal after the fifth intrathecal injection. Even more appealing, no acute or chronic adverse reactions were observed during injection and subsequent follow-up. In conclusion, intrathecal tocilizumab seems to be more rapid and effective than intravenous administration for immune-mediated CNSC manifested as CRS in haplo-HSCT recipients. We recommend this treatment modality for further investigation.http://www.sciencedirect.com/science/article/pii/S2405844024163876TocilizumabImmune-mediated central nervous system complicationHaploidentical hematopoietic stem cell transplantationIntrathecal therapyCase report |
| spellingShingle | Ruirui Gui Zhen Li Juan Wang Yingling Zu Binglei Zhang Juanjuan Zhao Yongping Song Jian Zhou Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports Heliyon Tocilizumab Immune-mediated central nervous system complication Haploidentical hematopoietic stem cell transplantation Intrathecal therapy Case report |
| title | Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports |
| title_full | Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports |
| title_fullStr | Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports |
| title_full_unstemmed | Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports |
| title_short | Intrathecal tocilizumab for immune-mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children: Two case reports |
| title_sort | intrathecal tocilizumab for immune mediated central nervous system complication after haploidentical hematopoietic stem cell transplantation in children two case reports |
| topic | Tocilizumab Immune-mediated central nervous system complication Haploidentical hematopoietic stem cell transplantation Intrathecal therapy Case report |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024163876 |
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