复发/难治性 B 细胞淋巴瘤患者单用 CAR-T 细胞或联合自体干细胞移植的不良反应

(1) Background: The combination of CAR-T with ASCT has been observed to enhance the efficacy of CAR-T cell therapy.

However, the impact of this combination on adverse reactions is still uncertain. (2) Methods: Between January 2019 and February 2023, 292 patients diagnosed with r/r B-cell lymphoma received either CAR-T therapy alone or in combination with ASCT at our institution.

We evaluated the incidence of CRS and CRES and utilized a logistic regression model to identify factors contributing to severe CRS (grade 3-4) and CRES (grade 3-4). (3) Results: The overall incidence of CRS and CRES was 78. 9% and 8. 2% in 147 patients receiving CAR-T alone, and 95. 9% and 15. 2% in 145 patients receiving CAR-T combined with ASCT, respectively. The incidence of overall CRS ( p < 0. 0001) and mild CRS (grade 1-2) ( p = 0. 021) was elevated in the ASCT combined with CAR-T group. No significant difference was observed in severe CRS and CRES between the groups.

Among the 26 cases of lymphoma involving the central nervous system (CNS), 96. 2% (25/26) developed CRS (15. 4% grade 3-4), and 34. 6% (9/26) manifested CRES (7. 7% grade 3-4). Female patients had a lower incidence of severe CRS but a higher incidence of severe CRES. Lymphomas with CNS involvement demonstrated a higher risk of CRES compared to those without central involvement. (4) Conclusions: The combination of ASCT with CAR-T demonstrated a preferable option in r/r B-cell lymphoma without an increased incidence of severe CRS and CRES.