内皮激活与应激指数评分作为 CAR-T 患者细胞因子释放综合征的预后因素——多发性骨髓瘤与大 B 细胞淋巴瘤队列的回顾性分析

Endothelial Activation and Stress Index (EASIX) has been proposed as a prognostic factor of adverse events or survival in hematological malignancies. Endothelial dysfunction has been associated with complications following stem cell transplantation and chimeric antigen receptor (CAR)-T therapy. This retrospective cohort study evaluated the utility of the EASIX score as a prognostic factor of cytokine release syndrome (CRS) in multiple myeloma/light-chain amyloidosis (MM/AL amyloidosis; N = 69) and large B-cell lymphoma (LBCL) cohorts (N = 65). Occurrence of CRS grade 3 was the primary endpoint. For both cohorts, the EASIX and simplified EASIX (s-EASIX) scores were calculated at four different time points before CAR-T infusion to assess its prognostic value.

In the MM/AL amyloidosis cohort, neither EASIX nor s-EASIX scores calculated at any time point were associated with the occurrence of CRS grade 3. In the LBCL cohort, EASIX and s-EASIX scores measured before lymphodepletion (EASIX-pre and s-EASIX-pre) showed a significant relationship with CRS grade 3 (odds ratio [OR] = 1.

06 and OR = 1. 05, respectively). The cutoff value of 1. 835 for EASIX-pre was associated with 4. 59-fold increased OR of CRS grade 3 (95% confidence interval [CI]: 1. 13-21. 84), whereas s-EASIX-pre cutoff equaled 2. 134 and was associated with 4. 13-fold increased OR of CRS grade 3 (95% CI: 1. 01-17. 93).

However, after internal validation with bootstrapping, the significance was lost both for the EASIX-pre and s-EASIX-pre cutoff. The presented findings indicate that the EASIX scores fail to predict CRS in MM/amyloidosis CAR-T patients, whereas they can be implemented as CRS grade 3 predictors in LBCL CAR-T patients.