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.
CAR-T（CAR-T）细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
基线认知与神经状态不改变侵袭性 B 细胞淋巴瘤 CAR-T 细胞治疗中 ICANS 的发生
英文原题：Baseline Cognitive and Neurological Status Does Not Modify the Occurrence of ICANS in CAR T-Cell Therapy for Aggressive B-Cell Lymphoma.
查看英文原题
Baseline Cognitive and Neurological Status Does Not Modify the Occurrence of ICANS in CAR T-Cell Therapy for Aggressive B-Cell Lymphoma.
分数与星级只用于站内排序 —— 不代表疗效、安全性或个人适用性。
研究概要
我们的结果表明，既往存在的认知障碍或神经系统病史不会增加 ICANS 的风险。
研究思路结论见上方概要
背景
免疫效应细胞相关神经毒性综合征（ICANS）是CAR-T 细胞治疗血液肿瘤常见且严重的并发症。本研究评估基线认知状态和既往神经系统损伤对ICANS发生的影响。
方法
我们开展了一项前瞻性研究，纳入2020年5月至2023年12月期间在本中心接受CAR-T 细胞治疗侵袭性B细胞淋巴瘤的成年患者。所有患者均接受了神经系统检查、脑MRI以及通过蒙特利尔认知评估（MoCA）测定的认知评估。我们在CAR-T 细胞输注前检测了总代谢肿瘤体积（TMTV）、乳酸脱氢酶（LDH）、白蛋白、铁蛋白和C反应蛋白（CRP），以及血清神经丝轻链（NfL）水平。我们采用多因素分析评估了这些因素对ICANS发生的影响。
结果
在156例接受CAR-T 细胞治疗的成年患者中，32.7%发生了ICANS。基线时MoCA评分中位数为26 [IQR 24; 28]。ICANS的发生与基线认知表现无显著关联（p 0.57）。MoCA评分不因ICANS分级而不同。既往存在的神经系统损伤与ICANS风险增加无关。在多变量分析中，使用CD28 CAR-T 细胞是ICANS最强的预测因素（p = 0.007）。白细胞分离时血清NfL水平轻度升高可预测ICANS（p = 0.046），支持其在预测神经毒性风险而非既往神经系统疾病中的作用。
展开英文摘要原文
BACKGROUND
Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common, serious complication of CAR T-cell therapy for blood cancers. This study evaluates the impact of baseline cognitive status and pre-existing neurological injury on the occurrence of ICANS.
METHODS
We conducted a prospective study of adult patients treated with CAR T-cell therapy for aggressive B-cell lymphoma at our centre between May 2020 and December 2023. All patients underwent neurological examination, cerebral MRI and cognitive assessment measured by the Montreal Cognitive Assessment (MoCA). We measured total metabolic tumour volume (TMTV), lactate dehydrogenase (LDH), albumin, ferritin and C-reactive protein (CRP) before CART cell infusion, and serum neurofilament light chain (NfL) levels. We evaluated the impact of these factors on ICANS occurrence using multivariate analysis.
RESULTS
Among the 156 adult patients treated with CAR T-cell therapy, 32.7% developed ICANS. The median MoCA score at baseline was 26 [IQR 24; 28]. There was no significant association between the onset of ICANS and baseline cognitive performance (p 0.57). MoCA scores did not differ by ICANS grade. Pre-existing neurological injury were not associated with increased ICANS risk. In multivariable analysis, the use of CD28 CAR T cells was the strongest predictor of ICANS (p = 0.007). Slightly elevated serum NfL levels at leukapheresis predicted ICANS (p = 0.046) supporting its role in predicting risk of neurotoxicity rather than pre-existing neurological disease.
CONCLUSIONS
Our results suggest that pre-existing cognitive impairment or neurological history do not increase the risk of ICANS.
论文信息
- 作者
- Ursu R、Barsan C、Di Blasi R、Belin C、Cuzzubbo S、El Soudany M、Cristinelli C、Sivapragassame R
- 单位
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Service de Neurologie, Paris, France.France
- 期刊
- European journal of neurology2025 Jun
- 原文标识
- PubMed 40542557 · DOI 10.1111/ene.70236
在 PubMed 查看 → 出版商原文（DOI） 全文 PDF（PMC）· 可下载 治疗专题与资料阅读指南 资料来源与翻译说明 报告译文或资料问题 →