As in the future, T cell-engaging immunotherapeutic agents will increasingly be used outside of clinical studies and academic cancer centers it becomes paramount that oncologists and intensive care specialists are familiar with this complication and its clinical management. Thus, most of the current CRS data is derived from CAR T cell and blinatumomab studies in hematologic malignancies where CRS has been reported in frequencies of up to 100% in CD19-targeted CAR T cell trials, sometimes with fatal outcome (Table 1). blinatumomab and CD19-targeted CAR T cells revealed that CRS is the most important adverse event of these therapies. Studies of the first T cell-engaging therapies, i.e. These include dual-affinity re-targeting antibodies (DART), immune-mobilising monoclonal TCRs against cancer (ImmTAC), and other TCR-based strategies. Furthermore, there are a number of related T cell-engaging immunotherapeutic approaches in earlier clinical development. Multiple other bispecific antibody and CAR T cell constructs that target a variety of antigens are currently in clinical development. Recently, the first two CAR T cell therapies tisagenlecleucel and axicabtagene ciloleucel received FDA approval for refractory CD19-positive B-ALL and relapsed or refractory large B-cell lymphoma. In 2014, the CD19-directed CD3 BiTE blinatumomab was approved for Philadelphia chromosome-negative relapsed or refractory B-cell precursor ALL under the FDA’s accelerated approval program. Both these immunotherapeutic strategies have recently been carried forward into clinical application and have shown impressive therapeutic activity in several hematologic malignancies, such as acute lymphoblastic B cell leukemia (B-ALL), chronic lymphocytic leukemia (CLL), and diffuse large B cell lymphoma (DLBCL). T cell-engaging immunotherapies include bispecific antibody constructs and chimeric antigen receptor (CAR) T cell therapies. Lately, with the success of the newer T cell-engaging immunotherapeutic agents there has been a growing interest in CRS since it represents one of the most frequent serious adverse effects of these therapies. Cytokine storm due to massive T cell stimulation is also a proposed pathomechanism of severe viral infections such as influenza. Furthermore, CRS was reported in the setting of haploidentical donor stem cell transplantation, and graft-versus-host disease. CRS has also been observed following administration of non-protein-based cancer drugs such as oxaliplatin and lenalidomide. Subsequently, CRS has been described after infusion of several antibody-based therapies such as anti-thymocyte globulin (ATG), the CD28 superagonist TGN1412, rituximab, obinutuzumab, alemtuzumab, brentuximab, dacetuzumab, and nivolumab. The term “cytokine release syndrome” was first coined in the early ‘90s, when the anti-T-cell antibody muromonab-CD3 (OKT3) was introduced into the clinic as an immunosuppressive treatment for solid organ transplantation. Hodgkin lymphoma chemotherapy first bite syndrome jaw pain.Cytokine release syndrome (CRS) is a systemic inflammatory response that can be triggered by a variety of factors such as infections and certain drugs. There appears to be a correlation between onset and duration of first bite symptoms with chemotherapy administration. We report a case of FBS, which may represent the jaw pain seen commonly with administration of vinca alkaloids. The patient noted resolution of symptoms after the completion of chemotherapy. A trial of botulinum chemodenervation failed to completely relieve symptoms. Pain was timed closely with chemotherapy administration and would improve prior to next cycle. ![]() Workup was negative for any lesions in the parotid, parapharyngeal space, or infratemporal fossa. Pain was worse with the first bite of each meal and dissipated over subsequent bites. A patient with Hodgkin lymphoma presented with unilateral jaw pain after beginning his chemotherapy regimen. We report a patient with first bite syndrome (FBS) during active treatment with chemotherapy. Vinca alkaloids are known to cause bilateral jaw pain that occurs once during the chemotherapy course.
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