Orthopnea From Phrenic Nerve Palsy After Ciltacabtagene Autoleucel CAR T-Cell Therapy in a Patient With Multiple Myeloma
- 1From Mayo Clinic Rochester, Rochester, Minnesota
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed the management of relapsed/refractory multiple myeloma (MM), particularly with the advent of ciltacabtagene autoleucel (cilta-cel). As its clinical use expands, novel and delayed toxicities are increasingly recognized. We report the first documented case of bilateral phrenic nerve palsy following cilta-cel infusion, presenting with acute dyspnea and profound orthopnea. Diagnostic evaluation was challenged by the patient's inability to tolerate the supine position, delaying definitive imaging. Ultimately, diaphragmatic ultrasound and phrenic nerve conduction studies confirmed isolated bilateral phrenic neuropathy without evidence of myopathy or cervical radiculopathy. The patient was treated with intravenous immunoglobulin (IVIG), high-dose corticosteroids, and prolonged bilevel positive airway pressure (BiPAP) support. Despite this neurologic complication, he achieved minimal residual disease (MRD)–negative complete remission. This case highlights an emerging neurotoxicity of cilta-cel, underscores the importance of early recognition of diaphragmatic dysfunction, and outlines diagnostic and management considerations for advanced practice providers (APPs).
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BibTeX
@article{fitzgerald2026orthopnea,
title = {{Orthopnea From Phrenic Nerve Palsy After Ciltacabtagene Autoleucel CAR T-Cell Therapy in a Patient With Multiple Myeloma}},
author = {Elizabeth C. Fitzgerald and Devon Altshuler and Allison M. Tanner and Supriya Gupta and Yi Lin},
journal = {Journal of the Advanced Practitioner in Oncology},
year = {2026},
month = sep,
doi = {10.6004/jadpro.2026.17.7.27},
url = {https://doi.org/10.6004/jadpro.2026.17.7.27},
note = {CC BY-NC-ND 3.0},
}
RIS
TY - JOUR
TI - Orthopnea From Phrenic Nerve Palsy After Ciltacabtagene Autoleucel CAR T-Cell Therapy in a Patient With Multiple Myeloma
AU - Elizabeth C. Fitzgerald
AU - Devon Altshuler
AU - Allison M. Tanner
AU - Supriya Gupta
AU - Yi Lin
PY - 2026
DA - 2026/09/01
JO - Journal of the Advanced Practitioner in Oncology
DO - 10.6004/jadpro.2026.17.7.27
UR - https://doi.org/10.6004/jadpro.2026.17.7.27
AB - Chimeric antigen receptor (CAR) T-cell therapy has transformed the management of relapsed/refractory multiple myeloma (MM), particularly with the advent of ciltacabtagene autoleucel (cilta-cel). As its clinical use expands, novel and delayed toxicities are increasingly recognized. We report the first documented case of bilateral phrenic nerve palsy following cilta-cel infusion, presenting with acute dyspnea and profound orthopnea. Diagnostic evaluation was challenged by the patient's inability to tolerate the supine position, delaying definitive imaging. Ultimately, diaphragmatic ultrasound and phrenic nerve conduction studies confirmed isolated bilateral phrenic neuropathy without evidence of myopathy or cervical radiculopathy. The patient was treated with intravenous immunoglobulin (IVIG), high-dose corticosteroids, and prolonged bilevel positive airway pressure (BiPAP) support. Despite this neurologic complication, he achieved minimal residual disease (MRD)–negative complete remission. This case highlights an emerging neurotoxicity of cilta-cel, underscores the importance of early recognition of diaphragmatic dysfunction, and outlines diagnostic and management considerations for advanced practice providers (APPs).
SN - 2150-0878
SN - 2150-0886
ER -