CTICasesROR1 CAR T-Cell Therapy-Induced Cytokine Release Syndrome
Imaging findings
Baseline chest radiography shows a soft tissue bulge in the upper mediastinum corresponding to a large sternal and soft tissue breast cancer metastasis. Follow-up radiograph obtained one day after the initiation of ROR1-targeted CAR T-cell therapy demonstrates the rapid development of diffuse, bilateral alveolar and interstitial opacities along with bilateral pleural effusions. Subsequent radiographs show rapid clearing of the parenchymal opacities and pleural effusions over approximately one week, while the baseline metastatic mass remains unchanged.
Key takeaways
CAR T-cell therapy directed against solid tumor antigens, such as ROR1 (receptor tyrosine kinase-like orphan receptor 1), can cause severe, acute systemic inflammatory reactions. Cytokine release syndrome (CRS) in this setting can manifest radiographically as rapid-onset pulmonary edema mimicking diffuse alveolar damage or acute respiratory distress syndrome (ARDS), which typically resolves quickly with supportive care and immunosuppressive treatment.
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