血液透析滤过处理CAR-T治疗后IL-6受体抑制剂治疗无效的3~4级细胞因子释放综合征3例  

Three cases of hemodiafiltration for the treatment of CAR-T related grade 3 - 4 cytokine release syndrome after ineffective treatment with IL-6 receptor inhibitors

作　　者：陈诗彧 陈伟红[1] 万晓春[2] 杜新[1] 罗畅如[1] 李晓清 张晓瀚[1] Chen Shiyu;Chen Weihong;Wan Xiaochun;Du Xin;Luo Changru;Li Xiaoqing;Zhang Xiaohan(Department of Hematology,The First Affiliated Hospital of Shenzhen University,Shenzhen Second People's Hospital,Shenzhen 518035,China;Protein and Cell Drug Research Center,Institute of Biomedicine and Technology,Shenzhen Institute of Advanced Technology,Chinese Academy of Sciences,Shenzhen 518055,China)

机构地区：[1]深圳大学第一附属医院/深圳市第二人民医院血液内科,深圳518035 [2]中国科学院深圳先进技术研究院、生物医药与技术研究所蛋白与细胞药物研究中心,深圳518055

出　　处：《中华血液学杂志》2022年第6期494-498,共5页Chinese Journal of Hematology

基　　金：深圳市科技创新委员会项目(JCYJ20180228163509339);科技部国家重点研发计划(2019YFA0906100);广东省科学技术项目(2019B020201014);深圳市卫生健康委员会项目(201606021)。

摘　　要：目的观察血液透析滤过(HDF)处理嵌合抗原受体T细胞(CAR-T细胞)免疫疗法后IL-6受体抑制剂治疗无效细胞因子释放综合征(CRS)的有效性及安全性.方法回顾性分析2015年7月至2021年7月深圳大学第一附属医院血液内科经CAR-T细胞治疗后出现托珠单抗治疗无效的3~4级CRS并接受HDF治疗的3例患者,包括急性B淋巴细胞白血病(B-ALL)2例,弥漫大B细胞淋巴瘤(DLBCL)1例.结果患者在HDF治疗结束后12h内临床症状(体温、血压、血氧)缓解,细胞因子IL-6、IL-10、TNF-α、INF-γ及C反应蛋白(CRP)明显下降.随访3个月未发现HDF治疗相关不良反应.结论HDF控制CAR-T细胞治疗后托珠单抗治疗无效3~4级CRS安全可行.Objective To investigate the efficacy and safety of hemodiafiltration(HDF)in treating CAR-T related grade 3-4 cytokine release syndrome after ineffective treatment with IL-6 receptor inhibitors.Methods Between July 2015 and July 2021,retrospective analysis of hemodiafiltration for the treatment of 3 patients,including 2 cases of acute B-lymphoblastic leukemia and 1 case of diffuse large B-cell lymphoma,with grade 3-4 CRS after CAR-T cell therapy and ineffective treatment with IL-6 receptor inhibitor was carried out.Results The patient's clinical symptoms,including body temperature,blood pressure,and blood oxygen,were relieved within 12 hours of all treatments,and the cytokines(IL-6,IL-10,TNF-α,INF-γ)and C-reactive protein(CRP)levels decreased significantly.No adverse side effects were observed during the follow-up period of 3 months.Conclusion HDF can be a safe and feasible method to treat CAR-T related grade 3-4 CRS after ineffective treatment with IL-6 receptor inhibitors.

关 键 词：血液透析滤过 嵌合抗原受体T细胞 细胞因子释放综合征 IL-6受体抑制剂 

分 类 号：R459.5[医药卫生—治疗学]