Efficacy and Safety of CAR-T Cell Therapy in Treatment of Elderly Patients with B-cell Acute Lymphoblastic Leukemia:A Clinical Study
王楣艳 1蔡梦洁 2朱明清 2仇惠英2
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 苏州大学附属第一人民医院,苏州 215006;昆山市第三人民医院,昆山 215300
2. 苏州大学附属第一人民医院,苏州 215006
折叠
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.
Abstract
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=0.000 6);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.
维普
万方数据