CELL INTELLIGENCE · 肿瘤细胞治疗研究

CAR (chimeric antigen receptor) T-cell therapies have transformed treatment for relapsed and refractory B cell lymphomas (r/r BCL) and plasma cell myeloma. While real-world experiences have shown success across age groups, patients over 70 years require special attention due to therapy-related complications like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can lead to adverse outcomes. This study analyzed outcomes of 26 r/r BCL patients aged 70 years treated with CAR T-cell therapy between 2019 and 2023, comparing those who received prophylactic Tocilizumab (N = 7) versus standard treatment (N = 19). The median age was 75 years, with patients having received a median of three prior therapy lines. Prophylactic Tocilizumab was given 1 h before re-transfusion of CAR T-cells. Patients receiving prophylactic Tocilizumab experienced significantly fewer therapy-related complications (p = 0.039) which were defined as one or more of the following events: severe CRS, severe ICANS, corticosteroid use, need for transfusions, treatment in a critical care unit, prolonged hospitalization and discharge to a care facility. Hospital stays in total were shorter in the Tocilizumab group (15.9 vs. 18.5 days), though not statistically significant. Progression-free and overall survival were similar between groups. The results suggest that prophylactic Tocilizumab may optimize management of older CAR T-cell patients, aligning with existing evidence regarding its prophylactic use in r/r BCL.