CD19 CAR-T细胞治疗骨髓侵犯B细胞淋巴瘤疗效分析

Therapeutic effect of anti-CD19 CAR-T cells on B cell lymphoma patients with bone marrow invasion

目的:探讨抗CD19 CAR-T细胞治疗骨髓侵犯的复发难治B细胞非霍奇金淋巴瘤(R/R B-NHL)患者的疗效和不良反应。方法:对2017年11月至2018年5月郑州大学第一附属医院肿瘤科收治的5例骨髓侵犯的R/R B-NHL患者应用抗CD19 CAR-T细胞治疗,观察疗效及不良反应。结果:输注后28 d评估近期疗效,并进行骨髓检查,4例患者取得完全缓解(CR)和微小残留病变(MRD)转阴,1例患者取得部分缓解(PR),骨髓活检显示均无淋巴瘤骨髓侵犯。5例患者均发生细胞因子释放综合征(CRS),4例患者发生2级CRS,1例患者发生4级CRS,治疗后均得到控制,中位随访时间18(12~19)个月,5例患者均无复发。结论:抗CD19 CAR-T细胞治疗伴随骨髓侵犯的R/R B-NHL患者长期疗效良好,不良反应可控。

Objective:To investigate the efficacy and adverse reactions of anti-CD19 CAR-T cells in refractory relapsed(R/R) B-cell non-Hodgkin lymphoma(B-NHL) patients with bone marrow invasion.Methods:Five patients with R/R B-NHL and bone marrow invasion were admitted to the Oncology Department of the First Affiliated Hospital of Zhengzhou University from November 2017 to May 2018.They were treated with CD19 CAR-T cells,the efficacy and adverse reactions were assessed and observed.Results:The short-term efficacy evaluation was performed 28 days after the infusion for all patients,and bone marrow examination was also performed.4 patients achieved complete response(CR) and MRD-(minimal residual disease),1 patient achieved PR(partial response).No lymphoma cells invasion showed in 5 patients′ bone marrow biopsy.All patients developed cytokine release syndrome(CRS),four patients developed grade Ⅱ CRS and one patient developed grade Ⅳ CRS.CRS were controlled after treatment.The median follow-up time was 18(12-19) months.All 5 patients had no recurrence till now.Conclusion:Anti-CD19 CAR-T cells are effective in treating patients with R/R B-NHL with bone marrow invasion.The most problematic side effect is CRS,which can be controlled by therapy.