CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1639892
This article is part of the Research TopicHost Features Affecting CAR T Cell Therapy of Hematological MalignanciesView all 5 articles
Case Report: Posterior Reversible Encephalopathy Syndrome (PRES) after CD19 Chimeric Antigen Receptor Therapy (CAR-T) for B-Acute Lymphoblastic Leukemia (B-ALL)
Provisionally accepted
- Saint Louis University, St. Louis, United States
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Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition characterized by distinctive radiologic findings and altered mental status, often associated with chemotherapy or systemic endothelial dysfunction. To date, there have been no documented cases of PRES occurring after chimeric antigen receptor T-cell therapy (CAR-T) for B-cell acute lymphoblastic leukemia (B-ALL). We describe the case of a 30-year-old female with relapsed B-ALL who received brexucabtagene autoleucel and subsequently developed progressively worsening cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). On Day 15, post-infusion, she developed acute encephalopathy and hypertension. Brain MRI revealed new, symmetric bilateral cortical and subcortical T2/ fluid-attenuated inversion recovery (FLAIR) hyperintensities consistent with a diagnosis of PRES. Treatment with multiple courses of anti-seizure medications, anti-cytokine therapy, and high-dose pulse corticosteroids led to complete clinical recovery and resolution of imaging abnormalities. To our knowledge, this represents the first reported case of PRES following CD19-directed CAR-T for B-ALL. This case highlights the potential for PRES as a complication of CAR-T mediated by cytokine-induced cerebrovascular endothelial injury. It also raises the possibility that a prior history of vasculitis, such as lymphomatoid granulomatosis, may predispose patients to an elevated risk of developing CAR-T-associated PRES.
Keywords: Chimeric Antigen Receptor Therapy (CAR-T), Immune Effector Cell-Associated Neurotoxicity Syndrome, Cerebrovascular dysfunction, Acute Lymphoblastic Leukemia, Posterior Reversible Encephalopathy Syndrome
Received: 02 Jun 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Agarwal, Kunwor and .Sudanagunta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rohan Dipesh Agarwal, Saint Louis University, St. Louis, United States
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