大B细胞淋巴瘤CAR-T细胞治疗后延迟性血细胞减少的临床特征及预后分析  

Clinical characteristics and prognostic analysis of prolonged cytopenia after CAR-T cell therapy in LBCL patients

作　　者：朱慧颖 赵丹青[1] 庄喆 阮菁 陈超 张薇[1] 周道斌[1] 张炎[1] Zhu Huiying;Zhao Danqing;Zhuang Zhe;Ruan Jing;Chen Chao;Zhang Wei;Zhou Daobin;Zhang Yan(Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院血液内科,北京100730

出　　处：《中华内科杂志》2024年第12期1238-1245,共8页Chinese Journal of Internal Medicine

基　　金：北京协和医院中央高水平医院临床科研专项(2022-PUMCH-B-029);首都卫生发展科研专项(2024-2-4011)。

摘　　要：目的探讨大B细胞淋巴瘤(LBCL)患者接受靶向CD19嵌合抗原受体T细胞(CAR-T细胞)治疗后出现延迟性血细胞减少(PC)的临床特征及预后。方法回顾性病例系列研究。收集2019年3月至2023年12月于北京协和医院血液科接受CAR-T细胞治疗且生存时间超1个月的27例LBCL患者的临床资料。统计分析LBCL患者CAR-T回输后第1、3、6、12个月的血细胞变化情况、无进展生存(PFS)期及治疗后感染事件等不良反应,并根据CAR-T细胞治疗后第90天是否出现血细胞减少分为PC组、非PC组,比较两组患者的组间差异,采用单因素logistic回归模型分析发生PC的危险因素。结果27例LBCL患者接受CAR-T细胞治疗的中位年龄为58岁(范围27~69岁),男性18例;19例(70.4%)出现PC,分别为粒细胞减少(13例,48.1%)、贫血(10例,37.0%)、血小板减少(6例,22.2%)。logistic单因素分析显示既往化疗敏感(OR=18.00,95%CI 1.56~207.45,P=0.020)、既往治疗后出现骨髓抑制(OR=18.00,95%CI 1.38~235.69,P=0.028)与PC相关。中位随访时间13.5个月,与非PC组相比,PC组3个月内感染风险增加(9/19比1/8),平均PFS期更短(19.3个月比24.4个月),但差异均无统计学意义(均P>0.05)。结论CAR-T细胞治疗后PC常见,PC患者感染风险高,并且与预后不良相关。既往化疗敏感和既往治疗后出现骨髓抑制与PC发生可能有关。ObjectiveTo investigate the clinical features and prognosis of prolonged cytopenia(PC)in patients with large B-cell lymphoma(LBCL)undergoing anti-CD19 chimeric antigen receptor T(CAR-T)cell therapy.MethodsA retrospective case series study was conducted on LBCL patients who received CAR-T cell therapy with a survival time of over one month at the Hematology Department of Peking Union Medical College Hospital from March 2019 to December 2023.Statistical analyses were performed on hematologic changes at 1,3,6,and 12 months post-CAR-T infusion,as well as on the progression-free survival(PFS)and post-treatment adverse events,including infections.Patients were categorized into the PC and non-PC groups based on the occurrence of cytopenia at 90 days post-infusion.Differences between groups were compared,and univariate logistic regression analysis was used to identify risk factors.ResultsThe median age of 27 LBCL patients receiving CAR-T cell therapy was 58 years(range 27-69 years),with 18 males.Among the 27 LBCL patients who received CAR-T cell therapy,PC was observed in 19 patients(70.4%),with instances of neutropenia(48.1%,13 cases),anemia(37.0%,10 cases),and thrombocytopenia(22.2%,6 cases).Univariate logistic regression analysis revealed that prior chemotherapy sensitivity(OR=18.00,95%CI 1.56-207.45,P=0.020)and bone marrow suppression(OR=18.00,95%CI 1.38-235.69,P=0.028)were associated with PC.The median follow-up time was 13.5 months.The PC group exhibited a higher risk of infection within 3 months(9/19 vs.1/8)and a shorter mean PFS(19.3 months vs.24.4 months),although the difference was not statistically significant(both P>0.05).ConclusionsPC is common following CAR-T cell therapy and is associated with an increased risk of infection and poorer prognosis.Prior treatment sensitivity and bone marrow suppression may serve as indicators of PC.

关 键 词：淋巴瘤 大B细胞 嵌合抗原受体T细胞治疗 血细胞减少 

分 类 号：R733.1[医药卫生—肿瘤]