IL-10 联合 EASIX 评分预测抗 CD19 CAR-T 细胞治疗后的出血事件

Chimeric antigen receptor (CAR) T-cell-associated coagulopathy can cause bleeding events. To explore risk factors for hemorrhage after CAR T-cell therapy, we retrospectively analyzed routine indicators in 56 patients with non-Hodgkin lymphoma and B-cell acute lymphoblastic leukemia who received anti-CD19 CAR T-cell therapy. Disturbance of coagulation occurred mainly within one month post infusion, especially on day 7 and 14. The cumulative incidence of bleeding events within one month was 32. 8%, with the median onset of 7 (range, 0-28) days. All bleeding events were grade 1-3. Patients who experienced bleeding events within one month had longer prothrombin time, higher IL-6, higher IL-10, and lower platelets before lymphodepletion. There were also correlations among coagulation-, inflammatory-, and tumor burden-related markers.

Multi-variate analysis showed IL-10 (> 7. 98 pg/mL; adjusted odds ratio [OR], 13. 84; 95% confidence interval [CI], 2. 03-94. 36; P = 0. 007) and the endothelial activation and stress index (EASIX, defined as dehydrogenase [U/L] creatinine [mg/dL] / platelets [ 10 9 cells/L]; >7. 65; adjusted OR, 7. 06; 95% CI, 1. 03-48. 23; P = 0. 046) were significant risk factors for bleeding events.

IL-10 plus the EASIX defined three risk groups for bleeding events with cumulative incidence of 100% (hazard ratio [HR], 14. 47; 95% CI, 2. 78-75. 29; P < 0. 0001), 38. 5% (HR, 3. 68; 95% CI, 0. 82-16. 67; P = 0. 089), and 11. 8% (reference), respectively. Future studies are needed to verify the risk assessment models for bleeding events after CAR T-cell treatment in larger cohorts.