接受CAR-T细胞治疗的复发/难治性B细胞非霍奇金淋巴瘤患者新型冠状病毒感染特点及其影响因素

Characteristics and impact factors of SARS-CoV-2 infection in adult patients with relapsed/refractory B-cell non-Hodgkin lymphoma receiving chimeric antigen receptor T-cell therapy

目的探究复发/难治性B细胞非霍奇金淋巴瘤(R/R B-NHL)患者接受嵌合抗原受体T细胞(CAR-T细胞)治疗前后感染新型冠状病毒(新冠病毒)的临床特点及治疗情况,以及接受CAR-T细胞治疗的患者新冠病毒重症感染的影响因素。方法回顾性研究2017年12月至2023年2月于华中科技大学同济医学院附属同济医院血液内科和浙江大学医学院附属第二医院血液内科接受CAR-T细胞治疗,并且在2022年12月至2023年2月首次感染新冠病毒的59例R/R B-NHL患者的资料,根据新冠病毒感染严重程度将患者分为轻型、中型、重型、危重型,对各组临床特征进行组间比较,并采用单因素Logistic回归分析影响新冠病毒重症感染的影响因素。同时对B细胞再生障碍(BCA)及非BCA组病例的临床特征进行比较。结果59例患者新冠病毒感染临床分型:39例(66.1%)轻型,9例(15.3%)中型,10例(16.9%)重型,1例(1.7%)危重型。年龄>55岁、接受过自体造血干细胞移植、诊断新冠病毒感染时为疾病进展状态以及BCA状态是新冠病毒重症感染的影响因素。BCA组患者新冠病毒感染严重程度较非BCA组更重(P<0.001),新冠病毒阳性持续时间更长(P=0.015),抗病毒治疗周期更久(P<0.001),住院治疗率更高(P<0.001)。结论在CAR-T细胞治疗的R/R B-NHL患者中,积极预防及治疗新冠病毒感染仍是亟须关注的问题。

Objective To explore the clinical characteristics and treatment of COVID-19 infection in patients with relapsed/refractory B-cell non-Hodgkin lymphoma before and after receiving chimeric antigen receptor T-cell therapy,and study the influencing factors of severe COVID-19 infection in these patients.Methods The data of 59 patients with relapsed/refractory B-cell non-Hodgkin lymphoma who received chimeric antigen receptor T-cell therapy at the Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology and Department of Hematology,the Second Affiliated Hospital,College of Medicine,Zhejiang University between December 2017 and February 2023,and who were infected with novel coronavirus between December 2022 and February 2023 were retrospectively studied.Patients were divided into light,medium,severe,and critical groups,and the differences between the groups were analyzed using the chi-square test.A univariate logistic regression model was used to evaluate the contribution of each variable and its relationship with severe infection.The chi-square and Fisher's exact tests were used to analyze the differences between the B-cell aplasia and B-cell recovery(BCR)groups.ResulstsOf the 59 pre-and post-infusion infections,39(66.1%)led to mild COVID-19,9(15.3%)resulted in moderate COVID-19,10(16.9%)resulted in severe COVID-19,and 1(1.7%)led to critical COVID-19.Moroever,age greater than 55 years,having received autologous hematopoietic stem cell transplantation,progressive disease status,and B-cell aplasia at the time of diagnosis of COVID-19 infection are factors affecting severe infection.Patients with B-cell aplasia had a more severe infection with COVID-19(P<0.001),a longer duration(P=0.015),a longer antiviral therapy course(P<0.001).and a higher hospitalization rate(P<0.001)than the BCR group.Conclusion Active prevention and treatment of COVID-19 infection remains a crucial issue requiring urgent attention in managing patients with relapsed/refractory B-cell non-Hodgkin lymphoma treated with chimeric antigen receptor T-cell therapy.