Ciltacabtagene autoleucel (cilta-cel) is a BCMA-directed CAR-T therapy approved for relapsed/refractory multiple myeloma. While cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are recognized CAR-T–related complications, reversible cerebral vasoconstriction syndrome (RCVS) had not been previously reported with cilta-cel.
In this case, a 63-year-old woman with RRMM and no vascular risk factors developed grade 1 CRS on day +10, treated with tocilizumab and vasopressors. On day +19 she presented with headache, leg weakness, and impaired fine motor function.
Neuroimaging revealed multifocal cerebral stenosis and ischemic strokes, initially raising suspicion for vasculitis; subsequent imaging established RCVS (RCVS2 score of 9). Despite immunomodulatory and cerebrovascular-directed therapies—including corticosteroids, anakinra, siltuximab, cyclophosphamide, verapamil, and nimodipine—neurological decline continued, culminating in right hemiplegia and higher-order visual–spatial deficits (Gerstmann’s and Balint’s syndromes).
By day +69, CT angiography indicated resolution of stenosis, yet persistent deficits remained. The authors highlight RCVS as a potential, life-threatening CAR-T–associated complication, possibly linked to CRS, tocilizumab, or midodrine, and call for broader differential diagnoses and targeted management strategies in CAR-T neurotoxicity.
Uncertainty remains regarding causality and optimal treatment.
Frontiers in Immunology published a clinical update in Infectious Disease on 02 Apr 2026.
The item focuses on Reversible cerebral vasoconstriction syndrome following ciltacabtagene autoleucel therapy for relapsed multiple myeloma: a case report.
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