嵌合抗原受体T细胞治疗的常见严重并发症

Serious complications of chimeric antigen receptor T cell therapy

嵌合抗原受体T细胞(CAR-T细胞)疗法已经发展为儿童和青少年难治复发淋巴系统恶性肿瘤的重要治疗手段。CAR-T细胞治疗在杀伤肿瘤细胞的同时也引发全身炎症反应,如细胞因子释放综合征(CRS)和免疫效应细胞相关神经系统毒性综合征(ICANS),累及各个系统甚至心肺功能和(或)神经系统功能迅速恶化的一系列免疫相关不良事件受到越来越广泛的重视。这些毒副反应的评估和分级在临床上差异较大,2018年美国移植和细胞治疗学会提出的通用CRS和ICANS分级帮助临床医护认识CAR-T细胞治疗过程中不良反应的发生发展,有效预防、早期诊断、规范管理、合理治疗,提高CAR-T细胞治疗的安全性和有效性。

Chimeric antigen receptor T cell(CAR-T)therapy is becoming the most promising treatment method in children and adolescent with refractory and relapse malignancies.While CAR-T cells exhibit powerful antitumour activity,this therapy has been associated with unique and significant toxicities including cytokine release syndrome(CRS)and immune effector cell-associated neurotoxicity syndrome(ICANS)by triggering immune effector cells,even develop rapid and life-threatening cardiovascular,respiratory and/or neurological dysfunction.The assessment and grading of these adverse events vary widely in different clinical trials and institutions.For integrating the definitions and grading systems for toxicities from immune effector responses,in 2018,the American Bone Marrow Transplantation Society proposed consensus definitions and grading which is objective and easy to apply for CRS and ICANS.It helps clinicians and nurses make early critical care assessment and guide critical care interventions,thereby improving the efficacy and safety of CAR-T therapy.