CAR-T细胞治疗儿童复发性B系急性淋巴细胞白血病所致细胞因子释放综合征临床分析

Clinical analysis of severe cytokine release syndrome caused by CAR-T cell therapy in children's intensive care unit

目的探讨CAR-T细胞疗法治疗儿童复发性B系急性淋巴细胞白血病(B-ALL)时出现的细胞因子释放综合征(CRS)的临床特征。方法回顾分析2019年1月至2020年6月收治的14例CAR-T细胞治疗的复发性B-ALL患儿的临床资料。结果14例复发性B-ALL输注CAR-T细胞后,9例发生严重CRS,11例患儿出现血流动力学不稳,5例需要机械通气,10例有神经系统症状,7例出现肝损害。14例患儿均使用托珠单抗治疗,7例静脉使用糖皮质激素,5例行血液净化治疗。3例患儿死亡,11例在2周内好转。结论CRS是CAR-T细胞输注后的常见毒性反应,可出现多器官功能障碍,CRS的严重程度与细胞因子IL-6、IFN-γ水平呈正相关。托珠单抗和激素是最主要的治疗方法,血液净化也是CRS的一种特殊治疗方法。

Objective To analyze the clinical features of severe cytokine release syndrome(sCRS)in children with relapsed B lineage acute lymphoblastic leukemia(B-ALL)treated by CAR-T cell therapy,and to summarize their treatment methods.Methods The clinical data of 14 cases of CAR-T cell therapy relapsed B-ALL children admitted to the intensive care unit from January 2019 to June 2020 were collected,and retrospectively analyzed.Results After CAR-T cell infusion,nine cases developed sCRS,eleven children developed hemodynamic instability,five cases required mechanical ventilation,ten cases had neurological symptoms,and seven cases had liver damage.All 14 patients were treated with tocilizumab,some of them were given glucocorticoids,and five patients were treated with continuous blood purification.Three patients died,and eleven patients recovered within two weeks.Conclusion CRS is a common toxic reaction after CAR-T cell infusion,which can cause multiple organ dysfunction.The severity of CRS was positively correlated with the levels of cytokines IL-6 and IFN-γ.Tocilizumab and corticosteroids are the main treatments,and the blood purification can also be used as a special treatment for C RS.