摘要
目的 探讨CAR-T细胞疗法治疗老年急性B淋巴细胞白血病(B-ALL)患者的安全性和有效性。方法 回顾性分析2020年5月—2022年12月苏州大学附属第一医院收治的接受CAR-T治疗的21例老年急性B淋巴细胞白血病患者的临床及随访资料,探讨CAR-T的有效性及安全性。结果 21例老年B-ALL患者CAR-T治疗后细胞因子释放综合征(cytokine release syndrome,CRS),中性粒细胞减少症和中性粒细胞缺乏症发生率分别为:38.1%(8/21),42.9%(9/21)和28.6%(6/21);与CAR-T回输前相比,CAR-T后一周白细胞绝对计数无显著差异,一个月后显著升高(P<0.001),中性粒细胞计数在CAR-T后一周和一个月均无显著差异(P>0.05),C反应蛋白在CAR-T后7天显著升高,30天后显著降低(-3 d vs 7 d,P=0.007;30 d vs 7 d,P=0.000 6);首次输注CAR-T后完全缓解率(complete remission,CR)为85.7%(18/21),中位随访时间为17个月;CAR-T后无进展生存率(progression-free survival,PFS)为81.0%,与性别、CAR-T细胞类型、费城染色体、高肿瘤负荷、桥接造血干细胞移植(HSCT)、治疗次数、LDH值以及血小板计数均无相关性(P>0.05),中位PFS为13个月;R/R B-ALL患者CAR-T治疗后CR率为75%(6/8),PFS率为67.5%,中位PFS时间为12个月;回输CAR-T后复发时间平均为10.2个月。结论 CAR-T细胞疗法用于治疗老年B-ALL患者具有较好的缓解率,为预后差的老年B-ALL患者提供有潜能的治疗手段。
Objective To investigate the efficacy and safety of CAR-T cell therapy in treating elderly patients with B-cell acute lymphoblastic leukemia(B-ALL).Methods Follow-up data were retrospectively analyzed for 21 B-ALL patients who underwent CAR-T cell therapy from May 2020 to December 2022 at The First Affiliated Hospital of Soochow University.We evaluated the therapy's outcomes and safety profile.Results Among the 21 elderly B-ALL patients treated with CAR-T treatment,the incidence rates of cytokine release syndrome(grade 1-2),neutropenia,and neutropenia were 38.1%(8/21),42.9%(9/21),and 28.6%(6/21),respectively.One week after CAR-T transfusion,there was no significant difference in absolute white blood cell count compared with pre-infusion levels,but a remarkable increase was observed one month later(P<0.001).Neutrophil counts remained unchanged at one week and one month post the treatment(P>0.05).C-reactive protein significantly increased 7 days after CAR-T and decreased after 30 days(-3 d vs 7 d,P=0.007;30 d vs 7 d,P=0.0006);After one year following CAR-T-cell transfusion,85.7%(18 of 21)patients achieved complete remission,with a median follow-up duration of 17 months.The progression free survival rate(PFS)after CAR-T was 81.0%,uncorrelated with the gender,CAR-T cell type,Philadelphia chromosome status,high tumor burden,history of hematopoietic stem cell transplantation,treatment times,LDH concentration and platelet count(P>0.05).The median PFS of elderly B-ALL patients with CAR-T was 13 months.For patients with relapsed or refractory(R/R)B-ALL,the CR rate and PFS rate were 75%and 67.5%,the median PFS was 12 months.The average relapse time was 10.5 months after infusion of CAR-T.Conclusion CAR-T cell therapy demonstrates a promising response rate in the treatment of elderly B-ALL patients,which provides a potential therapeutic avenue for this population with a poor prognosis.
作者
王楣艳
蔡梦洁
朱明清
仇惠英
WANG Meiyan;CAI Mengjie;ZHU Mingqing;QIU Huiying(The First Affiliated Hospital of Soochow University,The Third People's Hospital of Kunshan,Suzhou 215006)
出处
《临床输血与检验》
CAS
2024年第3期381-386,共6页
Journal of Clinical Transfusion and Laboratory Medicine
基金
江苏省老年健康科研面上项目(No.LKM2023015)资助。
