Case report: Treatment of parkinsonism secondary to ciltacabtagene autoleucel using a combination dopaminergic regimen

Raya Aliakbar; Olga Manouvakhova; Cindy Wong; Myo Htut; Johannes Pulst-Korenberg; Murali Janakiram; Michael Rosenzweig; Scott R Goldsmith; Xenos L Mason

doi:10.3389/fimmu.2024.1444010

Case report: Treatment of parkinsonism secondary to ciltacabtagene autoleucel using a combination dopaminergic regimen

Front Immunol. 2024 Sep 20:15:1444010. doi: 10.3389/fimmu.2024.1444010. eCollection 2024.

Affiliations

¹ Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, United States.
² Division of Multiple Myeloma, Department of Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, United States.

^# Contributed equally.

Abstract

We report on a patient with ciltacabtagene autoleucel-induced movement and neurocognitive toxicity, which was refractory to immunosuppression but responsive to combination dopaminergic therapy (carbidopa/levodopa, ropinirole, amantadine). Response was seen upon both initial treatment and rechallenge after unintended withdrawal. This is the first report of a successful symptomatic treatment of this well-described neurotoxic syndrome.

Keywords: CAR-T; ciltacabtagene autoleucel; movement and neurocognitive toxicity; multiple myeloma; parkinsonism.

Publication types

Case Reports

MeSH terms

Amantadine / administration & dosage
Amantadine / therapeutic use
Antiparkinson Agents / administration & dosage
Antiparkinson Agents / adverse effects
Biological Products / administration & dosage
Biological Products / adverse effects
Biological Products / therapeutic use
Carbidopa* / administration & dosage
Dopamine Agents / administration & dosage
Dopamine Agents / adverse effects
Dopamine Agonists / administration & dosage
Dopamine Agonists / adverse effects
Dopamine Agonists / therapeutic use
Drug Combinations
Drug Therapy, Combination
Female
Humans
Immunotherapy, Adoptive* / adverse effects
Immunotherapy, Adoptive* / methods
Indoles / administration & dosage
Indoles / adverse effects
Levodopa* / administration & dosage
Levodopa* / adverse effects
Male
Middle Aged
Parkinsonian Disorders / chemically induced
Parkinsonian Disorders / drug therapy
Receptors, Chimeric Antigen / immunology
Treatment Outcome

Substances

Carbidopa
Levodopa
carbidopa, levodopa drug combination
Drug Combinations
ropinirole
Amantadine
axicabtagene ciloleucel
Dopamine Agents
Indoles
Dopamine Agonists
Antiparkinson Agents
Biological Products
Receptors, Chimeric Antigen

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.