Blinatumomab-induced catastrophic immune effector cell-associated neurotoxicity with diffuse cerebral edema in a patient with ALL: Case report.
Xuemei Guo, Yuting Wei, Yongjun Fang et al.
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Case in brief
A 13-year-old boy with MLL-AF4-positive precursor B-ALL developed catastrophic neurotoxicity during blinatumomab therapy. After initially tolerating treatment, he experienced fever on day 13 of the second cycle, leading to confusion, seizures, and coma. Imaging revealed diffuse cerebral edema and suspected subarachnoid hemorrhage. Despite intensive management, he suffered irreversible neurological decline and loss of brainstem reflexes.
What made this case unusual
The case highlights a rare instance of delayed-onset, fatal neurotoxicity associated with blinatumomab, occurring after prior treatment tolerance and beyond the expected early treatment window.
Diagnostic / clinical pearl
Clinicians should be vigilant for neurological symptoms linked to fever during all phases of blinatumomab therapy, as severe neurotoxicity can occur unexpectedly.
Why it matters
This case emphasizes the need for further research to identify risk factors and improve monitoring strategies for neurotoxicity in pediatric patients receiving T-cell-engaging immunotherapy.