CAR-T细胞治疗老年急性B淋巴细胞白血病的临床研究*

doi:10.3969/j.issn.1671-2587.2024.03.014

临床输血与检验 ›› 2024, Vol. 26 ›› Issue (3): 381-386.DOI: 10.3969/j.issn.1671-2587.2024.03.014

CAR-T细胞治疗老年急性B淋巴细胞白血病的临床研究^*

王楣艳^1,2, 蔡梦洁¹, 朱明清¹, 仇惠英¹

¹苏州大学附属第一人民医院,苏州 215006;
²昆山市第三人民医院,昆山 215300

收稿日期:2024-02-08 出版日期:2024-06-20 发布日期:2024-06-24
通讯作者: 仇惠英,主要从事血液病学研究,（E-mail）qiuhuiying@aliyun.com。
作者简介:王楣艳,主要从事血液病临床工作,（E-mail）2832714992@qq.com。
基金资助:
*江苏省老年健康科研面上项目（No.LKM2023015）资助

Efficacy and Safety of CAR-T Cell Therapy in Treatment of Elderly Patients with B-cell Acute Lymphoblastic Leukemia: A Clinical Study

WANG Meiyan^1,2, CAI Mengjie¹, ZHU Mingqing¹, QIU Huiying¹

The First Affiliated Hospital of Soochow University, The Third People's Hospital of Kunshan, Suzhou 215006

Received:2024-02-08 Online:2024-06-20 Published:2024-06-24

摘要/Abstract

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。

关键词: 老年急性B淋巴细胞白血病, CAR-T细胞疗法, 预后

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.

Key words: Elderly B-cell acute lymphoblastic leukemia, CAR-T cell therapy, Prognosis

中图分类号:

R733.7

王楣艳, 蔡梦洁, 朱明清, 仇惠英. CAR-T细胞治疗老年急性B淋巴细胞白血病的临床研究^*[J]. 临床输血与检验, 2024, 26(3): 381-386.

WANG Meiyan, CAI Mengjie, ZHU Mingqing, QIU Huiying. Efficacy and Safety of CAR-T Cell Therapy in Treatment of Elderly Patients with B-cell Acute Lymphoblastic Leukemia: A Clinical Study[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2024, 26(3): 381-386.

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CAR-T细胞治疗老年急性B淋巴细胞白血病的临床研究^*

Efficacy and Safety of CAR-T Cell Therapy in Treatment of Elderly Patients with B-cell Acute Lymphoblastic Leukemia: A Clinical Study

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