We report 14 cases of immune effector cell (IEC)-associated enterocolitis following chimeric antigen receptor T-cell (CAR-T) therapy in multiple myeloma, with a 1.2% incidence overall (0.2% for idecabtagene vicleucel and 2.2% for ciltacabtagene autoleucel). Patients developed acute-onset symptoms (typically non-bloody Grade 3+ diarrhea) with negative infectious workup beginning a median of 92.5 days (range: 22–210 days) after CAR-T therapy and a median of 85 days after cytokine release syndrome resolution. Gut biopsies uniformly demonstrated inflammation, including intra-epithelial lymphocytosis and villous blunting. In one case where CAR-specific immunofluorescence stains were available, CAR T-cell presence was confirmed within the lamina propria. Systemic corticosteroids were initiated in 10 patients (71%) a median of 25.5 days following symptom onset, with symptom improvement in 40%. Subsequent infliximab or vedolizumab led to improvement in 50% and 33% of corticosteroid-refractory patients, respectively. Five patients (36%) have died from bowel perforation or treatment-emergent sepsis. In conclusion, IEC-associated enterocolitis is a distinct but rare complication of CAR-T therapy typically beginning 1–3 months after infusion. Thorough diagnostic workup is essential, including evaluation for potential T-cell malignancies. The early use of infliximab or vedolizumab may potentially hasten symptom resolution and lower reliance on high-dose corticosteroids during the post-CAR-T period.
我们报告了14例多发性骨髓瘤患者在接受嵌合抗原受体T细胞（CAR-T）治疗后出现免疫效应细胞（IEC）相关肠炎，总体发生率为1.2%（其中idecabtagene vicleucel为0.2%，ciltacabtagene autoleucel为2.2%）。患者症状急性起病（通常表现为非血性3级及以上腹泻），感染检查结果阴性，症状中位起始时间为CAR-T治疗后92.5天（范围：22-210天），且中位发生于细胞因子释放综合征缓解后85天。肠道活检均显示炎症改变，包括上皮内淋巴细胞增多和绒毛钝化。在一例可行CAR特异性免疫荧光染色的病例中，证实固有层内存在CAR T细胞。10例患者（71%）在症状出现后中位25.5天开始全身性皮质类固醇治疗，其中40%症状改善。后续在皮质类固醇难治患者中，英夫利昔单抗或维多珠单抗分别使50%和33%的患者症状改善。5例患者（36%）死于肠穿孔或治疗相关性脓毒症。总之，免疫效应细胞相关肠炎是CAR-T治疗中一种独特但罕见的并发症，通常于输注后1-3个月出现。彻底诊断检查至关重要，包括对潜在T细胞恶性肿瘤的评估。早期使用英夫利昔单抗或维多珠单抗可能加速症状缓解，并减少CAR-T后期间对大剂量皮质类固醇的依赖。
肿瘤(癌症)患者之家