霍奇金淋巴瘤CAR-T细胞治疗相关噬血细胞性淋巴组织细胞增生症1例分析  

Analysis of one case of hemophagocytic lymphohistiocytosis following CAR-T cell therapy for Hodgkin's lymphoma

作　　者：柳贵西 刘玉玉 李斑斑 白观臣[1] LIU Guixi;LIU Yuyu;LI Banban;BAI Guanchen(Department of Hematology,Tai'an City Central Hospital Affiliated to Qingdao University,Tai'an 271000,China)

机构地区：[1]青岛大学附属泰安市中心医院血液内科,山东泰安271000

出　　处：《山东医药》2025年第2期85-89,共5页Shandong Medical Journal

基　　金：山东省博士后科学基金资助项目(SDCX-ZG-202303060)。

摘　　要：目的分析1例霍奇金淋巴瘤嵌合抗原受体T(CAR-T)细胞治疗后发生噬血细胞性淋巴组织细胞增生症(HLH)患者的临床资料,总结该病的早期识别和有效治疗方法。方法对1例CAR-T细胞治疗后发生HLH的霍奇金淋巴瘤患者的临床资料进行回顾性分析。结果22岁女性患者,确诊为霍奇金淋巴瘤,经规律化疗联合异基因造血干细胞移植治疗后复发,经抗CD30 CAR-T细胞治疗后再次复发。人源化抗CD30/NKG2D CAR-T细胞治疗后,患者出现胸闷、憋喘、肝功能损伤、乳酸脱氢酶及铁蛋白升高、高直接胆红素血症、低纤维蛋白原血症等,结合临床症状与实验室检查结果,诊断为CAR-T细胞治疗相关HLH,即免疫效应细胞相关噬血细胞性淋巴组织增生症样综合征(IEC-HS)。应用糖皮质激素、芦可替尼、依托泊苷等治疗,HLH相关症状及指标好转。CAR-T细胞回输后第50天复查胸部CT提示左肺上叶炎症,考虑真菌感染,回输后第52天患者因肺出血死亡。结论IEC-HS是霍奇金淋巴瘤CAR-T细胞治疗的严重并发症,CAR-T细胞治疗后铁蛋白水平持续快速增高、靶器官损害及噬血现象有助于早期识别IEC-HS;确诊后给予糖皮质激素、芦可替尼及依托泊苷等治疗,有助于缓解症状。Objective To analyze the clinical data of a patient with hemophagocytic lymphohistiocytosis(HLH)fol lowing treatment with chimeric antigen receptor T(CAR-T)cells for Hodgkin's lymphoma,and to summarize the early identification and effective management of this condition.Methods We conducted a retrospective analysis of the clinical data from one patient diagnosed with Hodgkin's lymphoma who developed HLH after CAR-T cell therapy.Results A 22-year-old woman,initially diagnosed with Hodgkin's lymphoma,experienced recurrence after standard chemotherapy com bined with allogeneic hematopoietic stem cell transplantation.She subsequently relapsed again following anti-CD30 CART cell therapy.After receiving humanized anti-CD30/NKG2D CAR-T cell therapy,the patient presented symptoms includ ing chest tightness,dyspnea,liver function impairment,elevated lactate dehydrogenase and ferritin levels,hyperdirect bilirubinemia,and hypofibrinogenemia.Based on her clinical symptoms and laboratory findings,she was diagnosed with CAR-T cell therapy-related HLH,namely immune effector cell-associated hemophagocytic lymphohistiocytosis syndrome(IEC-HS).Following treatment with glucocorticoids,ruxolitinib,and etoposide,both HLH-related symptoms and associ ated laboratory indicators improved.A chest CT scan performed at 50 days after CAR-T cell transfusion revealed inflamma tion in the upper lobe of the left lung,and a fungal infection was suspected.Unfortunately,the patient died of pulmonary hemorrhage on day 52.Conclusions IEC-HS represents a serious complication arising from CAR-T cell therapy for Hodgkin's lymphoma.The rapid and sustained increase in ferritin levels alongside target organ damage and hemophagocy tosis following CAR-T treatment can facilitate early identification of IEC-HS.After the diagnosis is confirmed,administra tion of glucocorticoids along with ruxolitinib and etoposide helps to relieve the symptoms.

关 键 词：噬血细胞性淋巴组织细胞增生症 CAR-T细胞 细胞因子释放综合征 霍奇金淋巴瘤 

分 类 号：R733.4[医药卫生—肿瘤]