细胞因子诱导的杀伤细胞治疗恶性肿瘤安全性分析

Safety investigation of cytokine induced killer cell therapy in patients with malignant tumor

目的：观察细胞因子诱导的杀伤细胞（Cytokine-induced killer,CIK）在治疗恶性肿瘤中出现的不良反应,分析不良反应发生的可能机制,制定出具有针对性的防治措施,指导临床工作。方法：回顾性分析于2013年5月~2015年9月在我院接受CIK细胞治疗的1 240例恶性肿瘤患者的临床资料,包括治疗相关的各种不良反应、实验室检查、采取的相应防治措施及疗效等。结果：首次应用CIK细胞治疗后的不良反应包括：乏力（10%）、发热（7.25%）、寒战（4%）、关节疼痛（3%）、全身炎症反应综合征样反应（3%）、消化道不适（0.96%）、急性过敏样反应（0.08%）、皮疹（0.08%）、心绞痛（0.08%）、肿瘤溶解综合征（0%）、感染（0%）,随着治疗疗程增加,不良反应发生率增高,以发热为主要表现,于第4疗程后进入平台期,对于合并血压增高或下降、严重过敏样反应、类全身炎症反应综合征样反应、心绞痛者需对症处理,余无需特殊处理,在输注CIK细胞治疗前进行预处理可降低上述反应的发生率。结论：CIK细胞治疗恶性肿瘤方法总体上安全可靠,相关不良反应可控且可恢复,罕见不良反应可能存在潜在风险。

Objective： To observe the adverse reactions of killer cytokine-induced（ CIK） in the treatment of malignant tumor and to analyze the possible mechanism,and to develop the targeted prevention and treatment measures. Methods： The clinical data,including various adverse reactions,laboratory tests and the corresponding preventive measures against adverse reactions. In 1 240 patients with malignant tumor after treated with CIK cells from May 2013 to September 2015 were retrospectively analyzed. Results： The main adverse reactions after the first infusion of CIK cells were weak（ 10%）,fever（ 7. 25%）,shiver（ 4%）,arthralgia（ 3%）,systemic in flammatory response syndrome reaction（ 3%）,digestive tract discomfort（ 0. 96%）,acute allergic reaction（ 0. 08%）,rash（ 0. 08%）,angina pectoris（ 0. 08%）,tumor lysis syndrome（ 0%）,infection（ 0%）. With the increase of the treatment,the incidence of adverse reactions increased and the fever was the main performance,after the fourth course into the platform. The combination of blood pressure increased or decreased and severe allergic reaction and systemic inflammatory response syndrome was needed to be treated. The CIK cells were pretreated before treatment could reduce the incidence of these reactions. Conclusion： CIK cells therapy is a safe and effective adoptive immunotherapy for malignant tumor and its adverse reactions can be treated expectantly,but rare adverse reactions may have potential risks.