托珠单抗治疗CAR-T细胞治疗难治复发多发性骨髓瘤后细胞因子释放综合征的疗效  

Effects of tocilizumab regimen on cytokine release syndrome for patients with relapsed or refractory multiple myeloma treated by CAR-T cell immunotherapy

作　　者：张亦琳[1] 赵万红[1] 张王刚[1] 刘捷[1] 陈银霞[1] 曹星梅[1] 何爱丽[1] 王剑利[1] 杨楠[1] 杨云[1] 古流芳[1] 范晓虎 

机构地区：[1]西安交通大学医学院第二附属医院血液内科,陕西西安710004 [2]南京传奇生物科技有限公司,江苏南京210000

出　　处：《中国肿瘤生物治疗杂志》2017年第9期990-994,共5页Chinese Journal of Cancer Biotherapy

基　　金：西安交通大学第二附属医院重大医疗技术资助项目(No.XJS201601)~~

摘　　要：目的:观察托珠单抗治疗嵌合抗原受体修饰的T(CAR-T)细胞治疗难治复发多发性骨髓瘤(multiple myeloma,MM)后细胞因子释放综合征(cytokine release syndrome,CRS)的疗效。方法:以2016年2月至2017年2月西安交通大学第二附属医院血液内科住院的24例CAR-T细胞治疗难治复发MM患者为研究对象,对发生2级以上的CRS患者给予4~8 mg/(kg·d)的托珠单抗治疗,观察其疗效及毒副作用、细胞因子、超敏C反应蛋白(Hs CRP)等的变化。结果:24例患者中有21例患者发生了CRS,依据CRS分级标准:1、2级各7例,3级5例,4级2例。CRS患者均表现持续高热,细胞因子及Hs CRP明显升高,其中IL-6升高最为显著。14例2级以上CRS患者经托珠单抗治疗后,临床症状明显缓解、体温迅速下降,细胞因子、Hs CRP含量逐渐恢复正常,无明显毒副作用发生。结论:托珠单抗在CRS治疗中疗效明显、无明显毒副作用,保证了难治复发MM患者CAR-T治疗的安全性。Objective：To observe the therapeutic effect of tocilizumab on cytokine release syndrome（CRS） for patients with relapsed or refractory multiple myeloma（MM） treated by CAR-T cell immunotherapy.Methods：From February 2016 to February 2017,24 patients with relapsed or refractory multiple myeloma treated by CAR-T cell immunotherapy in the Department of Hematology of Second Affiliated Hospital of Medical College,Xi ＇an Jiaotong University were included as study subjects.Tocilizumab（4-8 mg/kg·d） was applied on MM patients with grade 2 or above,and the treatment efficacy,side effects,and the changes of hypersensitive C-reactive protein（Hs CRP） etc were observed.Results：Twenty-one of the 24 patients suffered from CRS during the CAR-T treatment.According to the CRS classification criteria,7 patients had grade 1 CRS reaction,7 patients with grade 2,5 patients with grade3,and 2 patients with grade 4.The manifestations of CRS were hyperpyrexia,significant increase in cytokines and Hs CRP level with the most obvious increase in IL-6.Fourteen CRS patients with grade 2 or above were treated by tocilizumab and their clinical symptoms were obviously alleviated：the temperature was rapidly decreased and cytokines and hypersensitive C-reactive protein dropped to normal gradually.In the process of treatment,no obvious side effects were observed.Conclusion：Tocilizumab showed a significant clinical efficacy in the treatment of CRS,which greatly guaranteed the safety of the MM patients in the CAR-T treatment.

关 键 词：托珠单抗 嵌合抗原受体修饰T细胞 多发性骨髓瘤 细胞因子释放综合征 

分 类 号：R730.51[医药卫生—肿瘤] R733.3[医药卫生—临床医学]