Effect of car-t Cell Immunotherapy on LDH,ALC,CD4+/CD8+ratio,Ki67 Expression in Patients with Relapsed and Refractory Diffuse Large B-cell Lymphoma
Objective To investigate the effects of chimeric antigen receptor T cell(car-t)immunotherapy on lactate dehydrogenase(LDH),absolute lymphocyte count(ALC),CD4+/CD8+ratio,and tumor proliferating antigen(Ki67)expres-sion in patients with relapsed/refractory diffuse large B cell lymphoma(DLBCL).Methods A total of 92 patients with relapsed/refractory DLBCL who were definitely diagnosed by car-t cell immunotherapy were retrospectively analyzed.Clinical outcomes and adverse effects were recorded in patients with relapsed/refractory DLBCL,and the levels of LDH,ALC,CD4+/CD8+ratio,and Ki67 were compared between patients with relapsed/refractory DLBCL before and after treatment.Pretreatment clinical character-istics,including gender,age,annarbor stage,ECoG score,site of extranodal involvement,international prognostic index(IPI),number of lines of car-t therapy,and pretreatment LDH,ALC,CD4+/CD8+ratio,and Ki67 levels,were evaluated in patients with different efficacies.Results After car-t immunotherapy,39 patients(42.39％)had Cr,24 patients(26.09％)had pr,18 patients(19.57％)had SD,and 11 patients(11.96％)had PD;The overall response rate was 63 patients(68.48％).71 pa-tients(77.17％)had adverse reaction cytokine release syndrome(CRS)and 73 patients(79.35％)had hypoimmunoglobuline-mia.LDH and Ki67 levels decreased and ALC and CD4+/CD8+ratio increased after car-t cell immunotherapy compared with those before treatment,respectively(P＜0.05).The age,annarbor stage,the number of extranodal involved sites,the number of IPI,LDH,Ki67 and car-t treatment lines of patients with DLBCL who failed to respond to treatment were higher than those in the effective treatment group,and the ALC and CD4+/CD8+ratios were lower than those in the effective treatment group(P＜0.05).Logistic regression analysis showed that advanced age,annarbor stage IV,number of sites with multiple extranodal involve-ment,high IPI score,car-t beyond second-line as well as increased levels of pretreatment LDH,Ki67 and decreased levels of ALC,CD4+/CD8+ratio were risk factors affecting the efficacy of car-t cell immunotherapy in DLBCL patients(P＜0.05).ROC curves were established,and the AUCs of LDH,ALC,CD4+/CD8+ratio,and Ki67 were 0.823,0.835,0.873,and 0.849,re-spectively,suggesting that LDH,ALC,CD4+/CD8+ratio,and Ki67 may have some predictive value for the efficacy of car-t cell immunotherapy.Conclusion car-t cell immunotherapy reduced LDH and Ki67 level expression and increased ALC and CD4+/CD8+ratio expression,and pretreatment LDH,ALC,CD4+/CD8+ratio,and Ki67 expression were predictive of car-t cell immu-notherapy efficacy.
Chimeric antigen receptor T cellsDiffuse large B-cell lymphomaLactate dehydrogenase LDHLymphocyte absolute valueTumor proliferation antigen
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