Chronic inflammatory demyelinating polyneuropathy (CIDP) after cilta-cel therapy

Korenkov, M.; Liebaert, J.; Yousefian, S.; Schwartz, S.; Demel, U.M.; Braune, J.; Odabasi, M.C.; Herzberg, L.; Böckle, D.; Görür, N.C.; V. Landenberg-Roberg, V.; Bohl, S.; Tregel, E.; Hennig, S.; Franke, C.; Haas, S.; Keller, U.; Krönke, J.; Busse, A.

Chronic inflammatory demyelinating polyneuropathy (CIDP) after cilta-cel therapy

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Item Type:	Article
Title:	Chronic inflammatory demyelinating polyneuropathy (CIDP) after cilta-cel therapy
Creators Name:	Korenkov, M., Liebaert, J., Yousefian, S., Schwartz, S., Demel, U.M., Braune, J., Odabasi, M.C., Herzberg, L., Böckle, D., Görür, N.C., V. Landenberg-Roberg, V., Bohl, S., Tregel, E., Hennig, S., Franke, C., Haas, S., Keller, U., Krönke, J. and Busse, A.
Abstract:	Ciltacabtagene-autoleucel (cilta-cel) is a CAR-T cell therapy highly active in relapsed/refractory multiple myeloma but can induce severe immune-mediated toxicities. We describe two patients who developed chronic inflammatory demyelinating polyneuropathy (CIDP) after cilta-cel. Patient 1 presented with rapidly progressive gait ataxia, flaccid paraparesis, and oculomotor palsy 112 days post infusion; Patient 2 developed an analogous syndrome on day 19. In both patients, electromyography and nerve-conduction studies confirmed sensorimotor axonal-demyelinating neuropathy; brain MRI and CSF infection panels were unremarkable. CAR-T cells were detectable in blood and CSF, yet a predominance of CD8⁺ non-CAR-Tcells was observed. TCR-β sequencing revealed a hyper-expanded clone (~30% of all reads) in patient 1 versus a polyclonal repertoire in patient 2. High-dose dexamethasone plus intravenous immunoglobulin failed to improve neurologic symptoms and prompted T-cell-depleting cyclophosphamide, which lowered CAR- and non-CAR-T cells. Patient 1 died from respiratory failure, whereas patient 2 improved and could be discharged. These observations indicate that CIDP is a severe complication of cilta-cel therapy and may arise from bystander expansion of autoreactive CD8⁺ T-cells rather than direct CAR-T cell activity. Timely escalation to T-cell-depleting therapy may improve outcomes.
Keywords:	Adoptive Immunotherapy, Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Source:	Blood Cancer Journal
ISSN:	2044-5385
Publisher:	Nature Publishing Group
Volume:	15
Number:	1
Page Range:	168
Date:	20 October 2025
Official Publication:	https://doi.org/10.1038/s41408-025-01384-9
PubMed:	View item in PubMed

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