肿瘤细胞治疗研究
英文原题：Autologous stem cell boost improves persistent immune effector cell associated hematotoxicity following BCMA directed chimeric antigen receptor T (CAR T) cell therapy in multiple myeloma.
在本研究中，60%（n = 61/101）的患者在D + 21时观察到ICAHT，其发生的风险因素包括既往ASCT史、既往治疗线数较多、淋巴细胞清除前血小板计数降低以及ICANS病史。
持续性免疫效应细胞相关血液毒性（ICAHT）是复发多发性骨髓瘤（MM）患者接受 BCMA CAR T 细胞治疗的一个显著副作用。在 ICAHT 中使用干细胞支持已有描述，然而研究受到患者数量少和随访时间短的限制。在此，我们报告了我们在接受 BCMA CAR T 治疗的患者中关于 ICAHT 的多机构经验，ICAHT 定义为绝对中性粒细胞计数（ANC）1000、血小板计数 50,000 的血小板减少症或/和血红蛋白（hgb）9 g/dL 的贫血，以及随后干细胞支持对造血重建和临床结局的影响。在本研究中，在 D + 21 时，60%（n = 61/101）的患者观察到 ICAHT，其发生的危险因素包括既往 ASCT 史、既往治疗线数较多、淋巴细胞清除前血小板计数降低以及 ICANS 史。28% 的 ICAHT 患者在中位 116 天时接受了干细胞支持，原因是严重且持续的细胞减少，常需要持续输血支持。干细胞支持在 3 个月和 6 个月随访时显著改善了细胞减少，且对 PFS 和 OS 没有任何不良影响，强调了该操作的安全性。
Persistent Immune Effector Cell Associated Hematotoxicity (ICAHT) is a significant side effect of BCMA CAR T-Cell therapy in patients with relapsed multiple myeloma (MM). The use of stem cell boosts in ICAHT has been described, however studies have been limited by small patient numbers and short follow up. Herein, we report on our multi-institutional experience of ICAHT, defined by an absolute neutrophil count (ANC) of 1000, thrombocytopenia with a platelet count 50,000 or/and anemia as hemoglobin (hgb) 9 g/dL, in patients who received BCMA CAR T therapy, and the effects of subsequent stem cell boost on hematopoietic reconstitution and clinical outcome. In this study, ICAHT was observed in 60% (n = 61/101) of patients at D + 21, and risk factors for its development included history of a prior ASCT, higher number of prior lines of therapy, a decreased platelet count prior to lymphodepletion and history of ICANS. 28% of patients with ICAHT received a stem cell boost at a median of 116 days due to profound and prolonged cytopenias often requiring ongoing transfusion support. Stem cell boost significantly improved cytopenias at 3 and 6 months follow up without any adverse effects on PFS and OS, underscoring the safety of this procedure.
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