血液肿瘤CAR-T细胞治疗后血细胞减少的研究进展

Research progress in cytopenia after CAR-T cell therapy for hematological malignancies

嵌合抗原受体(CAR)T细胞在血液肿瘤治疗中的有效性得到广泛认可。CAR-T相关不良反应有细胞因子释放综合征(cytokine release syndrome,CRS)、免疫效应细胞相关神经毒性综合征和血液学毒性。CAR-T后血液学毒性是多发性骨髓瘤、B细胞淋巴瘤、急性白血病患者中最常见的3级以上不良反应,受CRS反应及相关细胞因子、骨髓功能、CAR-T结构、清淋化疗、基线血细胞、铁蛋白峰值、既往治疗线数、造血干细胞移植状态等影响。血液学毒性影响患者预后,缩短无进展生存期、总生存期,增加感染风险以及死亡率。CAR-T输注前可使用CAR-HEMATOTOX评分模型进行基线风险评估,输注后可根据最新发表的CAR-T相关血液学毒性(ICAHT)共识进行ICAHT分级管理,以期提高患者生存率,改善预后。

The effectiveness of chimeric antigen receptor(CAR)T cells in the treatment of hematological tumors is obvious.CAR-T related adverse effects include cytokine release syndrome(CRS),immune effector cell associated neurotoxicity syndrome,and hematological toxicity.Hematological toxicity after CAR-T is the most common grade 3 or higher adverse event in patients with multiple myeloma,B-cell lymphoma,and acute leukemia.It is influenced by CRS and CRS related cytokines,bone marrow function,CAR-T structure,lymphodepletion chemotherapy,baseline absolute neutrophil count(ANC),baseline hemoglobin(Hb),baseline platelet,ferritin peak,previous therapy lines and previous hematopoietic stem cell transplantation.Hematologic toxicity affects the prognosis of patients,shortens progression free survival and overall survival,increases the risk of infection and mortality.Before CAR-T infusion,the CAR-HEMATOTOX scoring model could be used for evaluating hematologic toxicity.After infusion,ICAHT grading management could be carried out according to the latest published consensus on CAR-T related hematotoxicity(ICAHT),to improve the survival and prognosis of patient.