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| Item Type: | Letter |
|---|---|
| Title: | Chronic inflammatory demyelinating polyneuropathy (CIDP) after cilta-cel therapy |
| Creators: |
Korenkov, M.  ORCID: https://orcid.org/0000-0002-2988-8483, Liebaert, J. ORCID: https://orcid.org/0000-0002-2988-8483, Yousefian, S. ORCID: https://orcid.org/0000-0003-0902-0369, Schwartz, S. ORCID: https://orcid.org/0000-0001-8833-5793, Demel, U.M. ORCID: https://orcid.org/0000-0002-6480-4185, Braune, J. ORCID: https://orcid.org/0000-0003-2026-2641, Odabasi, M.C., Herzberg, L., Böckle, D., Görür, N.C. ORCID: https://orcid.org/0000-0001-7857-2461, V. Landenberg-Roberg, V., Bohl, S., Tregel, E., Hennig, S., Franke, C. ORCID: https://orcid.org/0000-0002-5609-2472, Haas, S. ORCID: https://orcid.org/0000-0001-9227-2051, Keller, U. ORCID: https://orcid.org/0000-0002-8485-1958, Krönke, J. and Busse, A. ORCID: https://orcid.org/0000-0002-3470-6947
|
| 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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