CAR-T治疗难治/复发B细胞肿瘤患者后继发第二肿瘤2例并文献复习

Second tumor after CAR-T therapy in refractory/relapsed B-cell tumor:Two cases study and literature review

目的分析基于嵌合抗原受体修饰的T细胞(chimeric antigen receptors-modified T cells,CAR-T)疗法在难治/复发B细胞肿瘤患者治疗中的临床特点及疗效。方法回顾分析2例B细胞肿瘤患者接受CAR-T治疗后继发第二肿瘤的病例资料并复习相关文献。结果1例诊断为滤泡性淋巴瘤,接受CD19及CD22 CAR-T治疗后,无进展生存期为28个月,后继发腺癌;1例诊断为急性B淋巴细胞白血病,接受CD19 CAR-T治疗后,无进展生存期为14个月,后继发急性髓系白血病。结论CAR-T治疗在B细胞肿瘤患者治疗中取得巨大突破,但这一疗法在临床应用中仍存在诱发第二肿瘤等远期不良反应,在临床实践中需要长期随访与总结。

ObjectiveTo analyze the clinical characteristics and efficacy of chimeric antigen receptors-modified T cells(CAR-T based therapy in the treatment of patients with refractory/relapsed B-cell tumor.MethodsThe data of 2 patients with B-cell tumor who developed a secondary tumor after CD19 and CD22 CAR-T therapy were retrospectively analyzed,and the related literature was reviewed.ResultsOne case was diagnosed as follicular lymphoma and had a progression-free survival of 28 months after treatment with CD19 and CD22 CAR-T therapy,followed by secondary adenocarcinoma;the other case was diagnosed as acute B-lymphoblastic leukemia and had a progression-free survival of 14 months after CD19 CAR-T therapy,followed by secondary acute myeloid leukemia.ConclusionsA great breakthrough is made in CAR-T therapy for the treatment of B-cell tumor patients.However,the therapy still has long-term adverse reactions in clinical application,such as the secondary tumor,which needs a long-term follow-up and summary in clinical practice.