CAR-T(CAR-T)细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Therapeutic efficacy and infectious complications of CD19-targeted chimeric antigen receptor-modified T cell immunotherapy.
Therapeutic efficacy and infectious complications of CD19-targeted chimeric antigen receptor-modified T cell immunotherapy.
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淋巴细胞清除化疗联合CD19靶向嵌合抗原受体修饰T细胞(CAR-T)免疫疗法,是治疗难治或复发B细胞恶性肿瘤的一种创新方法。该疗法也可能导致感染,但目前尚无对感染并发症的系统分析。
本研究拟分析本院40名接受CD19 CAR-T 细胞治疗患者在第0至90天的感染情况。采用泊松回归和Cox回归分别评估治疗前后感染危险因素。研究为队列研究,纳入急性淋巴细胞白血病、慢性淋巴细胞白血病及非霍奇金淋巴瘤患者。患者首次感染发生于CAR-T 细胞输注后中位第6天;8名患者(20%)在输注后28天内发生10次感染。90天内感染密度较低,为0.67;感染密度为每100天1.19次感染。2名患者(5%)发生侵袭性真菌感染,另2名患者(5%)发生危及生命或致命感染。在基线特征校正模型中,ALL、既往接受4线抗肿瘤治疗和接受最高剂量CAR-T 细胞的患者,前28天感染密度较高。CAR-T 输注后感染发生率与CAR-T 挽救治疗临床试验中观察到的感染发生率相当。
Lymphocyte depletion chemotherapy CD19-targeted chimeric antigen receptor-modified T (CAR-T) cell immunotherapy is an innovative approach for the treatment of refractory or relapsed B-cell malignancies. This method also has the occurrence of infection, and there has been no systematic analysis of infectious complications. In our study, we intend to analyze the infection in patients between day 0 and day 90 by analyzing the data of 40 patients who received CD19 CAR-T cell therapy collected in our hospital.
We assessed risk factors for infection before and after treatment using Poisson and Cox regression, respectively. A cohort study was used, including patients with acute lymphocytic leukemia, chronic lymphocytic leukemia and non-Hodgkin's lymphoma. 40 patients were infected for the first time occurred at a median of 6 days after CAR-T cell infusion, and 8 (20%) had 10 infections within 28 days after CAR-T cell infusion, on days 29 and 29. The infection density between 90 days was lower at 0. 67.
This resulted in an infection density of 1. 19 infections per 100 days. Two patients (5%) developed invasive fungal infections and two patients (5%) developed life-threatening or fatal infections. In an adjusted model for baseline characteristics, patients with ALL, 4 prior antitumor regimens, and receiving the highest CAR-T cell dose had higher infection densities at 28 days. The incidence of infection was comparable to that observed in clinical trials of salvage associated with infection after CAR-T cell infusion.
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