早期生物学标志物对CAR-T治疗复发/难治性多发性骨髓瘤中细胞因子释放综合征发生及严重程度预警的研究

Early biological markers for early warning of cytokine release syndrome occurrence and severity in relapsed/refractory multiple myeloma treated with CAR-T

目的:探讨嵌合抗原受体T细胞(chimeric antigen receptor T cell,CAR-T)治疗复发/难治性多发性骨髓瘤(relapsed/refractory multiple myeloma,R/R MM)早期生物学标志物对细胞因子释放综合征(cytokine release syndrome,CRS)的发生及严重程度的预警作用。方法:研究纳入2020年10月—2023年1月在徐州医科大学附属医院血液科接受CAR-T细胞治疗,并进行早期生物标志物检测的56例R/R MM患者。分析CAR-T细胞输注后前3天14种生物学标志物浓度水平变化与CRS的发生及严重程度的关系。结果:47例(83.9%)患者发生了CRS,包括43例(76.8%)轻度CRS(1~2级)和4例(7.1%)重度CRS(3~5级)。CRS发生的中位时间为CAR-T细胞输注后第8(4~23)天,中位持续时间是3(1~12)d。细胞输注后早期IL-6(OR=1.018,95%CI 1.000~1.036)和IL-10(OR=1.038,95%CI 1.002~1.074)浓度水平与CRS发生及严重程度密切相关,IL-6与IL-10联合预警CRS发生的灵敏度为65.96%,特异度为100.00%,预警重度(≥3级)CRS发生的灵敏度为100.00%,特异度为55.77%。结论:CAR-T治疗早期,IL-6和IL-10均可以预警CRS的发生,两者联合具有更高的灵敏度。

Objective To investigate the role of early biological markers of chimeric antigen receptor T cell(CAR-T)therapy for relapsed/refractory multiple myeloma(R/R MM)in early warning of the occurrence and severity of cytokine release syndrome(CRS).Methods Fifty-six patients with R/R MM who were treated with CAR-T cells and underwent early biomarker testing from October 2020 to January 2023 in the Department of Hematology,Affiliated Hospital of Xuzhou Medical University,were enrolled in this study.The relationship between changes in the concentration levels of 14 biological markers and the occurrence and severity of CRS in the first 3 days after CAR-T cell infusion were analyzed.Results CRS occurred in 47(83.9%)patients,including 43(76.8%)with mild CRS(grade 1-2)and 4(7.1%)with severe CRS(grade 3-5).The median time to the onset of CRS was day 8(4-23)after CAR-T cell infusion,and the median duration was 3 days(1-12).The levels of IL-6(OR=1.018,95%CI 1.000-1.036)and IL-10(OR=1.038,95%CI 1.002-1.074)concentrations in the early period after cell transfusion were strongly correlated with the occurrence and severity of CRS,and the sensitivity of the combined warning of the occurrence of CRS with IL-6 and IL-10 was 65.96%with a specificity of 100.00%,and the sensitivity of warning the occurrence of severe CRS(≥grade 3)was 100.00%and the specificity was 55.77%.Conclusion Early in CAR-T therapy,both IL-6 and IL-10 can warn of CRS,and the combination of the two has higher sensitivity.