2026-10-11T21:45:34Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33981736 2026-09-24T11:29:37Z category_7 portal_147 item_type_3 month_year_09_2026

Supplemental Material for: Severe Refractory Immune Effector Cell-Associated Enterocolitis After Ciltacabtagene Autoleucel With Clonal Persistence of CAR-T Construct-Positive T Cells in the Gastrointestinal Tract: A Case Report figshare admin karger (2628495) Hira Cheema (25103773) Syed Naqvi (2618557) Khadijah Adel Hassan Mahmoud Moustafa (25103774) Maurizio Zangari (9218326) Carolina Schinke (9218323) Sharmilan Thanendrarajan (9218329) Daisy Alapat (6883217) Frits Van Rhee (5489786) Medicine Medicine <p dir="ltr">Introduction:</p><p dir="ltr">Immune effector cell–associated enterocolitis is an emerging delayed toxicity after BCMA-directed CAR-T therapy for multiple myeloma. Severe cases may be refractory to corticosteroids and complicated by bowel injury, malnutrition, and prolonged need for parenteral nutrition.</p><p dir="ltr">Case Presentation:</p><p dir="ltr">We report a 69-year-old man with kappa free light chain multiple myeloma and AL amyloidosis who developed severe watery diarrhea, abdominal cramping, anorexia, weight loss, and debility several weeks after ciltacabtagene autoleucel. Initial infectious evaluation was negative. Endoscopic and histopathologic findings supported immune effector cell–associated enterocolitis, with epithelial apoptosis, crypt injury, and active inflammation. Gastrointestinal biopsies demonstrated a prominent atypical CD3-positive, CD4-positive T-cell infiltrate with relative CD7 loss and absence of CD8 expression in the atypical population. Molecular testing detected CAR-T construct transcripts and T-cell clonality, supporting clonal persistence or expansion of CAR-T construct–positive T cells in the gut without definitive evidence of overt CAR-T cell lymphoma. His course was complicated by steroid-refractory enterocolitis, pneumatosis intestinalis, pneumoperitoneum, malnutrition, and need for exploratory laparotomy without gross necrosis or frank perforation. He required bowel rest, total parenteral nutrition, intravenous immunoglobulin, and multimodal immunosuppression including infliximab, vedolizumab, ruxolitinib, tacrolimus, budesonide, systemic corticosteroids, and cyclophosphamide.</p><p dir="ltr">Conclusion:</p><p dir="ltr">This case highlights severe refractory immune effector cell–associated enterocolitis after ciltacabtagene autoleucel with biopsy-proven clonal persistence of CAR-T construct–positive T cells in gastrointestinal tissue. Tissue-based CAR-T construct testing and T-cell clonality assessment should be considered in severe or refractory post–CAR-T enterocolitis, particularly when biopsies show atypical T-cell infiltrates.</p> 2026-09-24T11:29:37Z Dataset Dataset 10.6084/m9.figshare.33981736.v1 https://figshare.com/articles/dataset/Supplemental_Material_for_Severe_Refractory_Immune_Effector_Cell-Associated_Enterocolitis_After_Ciltacabtagene_Autoleucel_With_Clonal_Persistence_of_CAR-T_Construct-Positive_T_Cells_in_the_Gastrointestinal_Tract_A_Case_Report/33981736 CC BY 4.0