肿瘤细胞治疗研究
英文原题：Dermatologic Adverse Events Following CD19-Directed CAR T-Cell Therapy in Hematologic Malignancies.
Dermatologic Adverse Events Following CD19-Directed CAR T-Cell Therapy in Hematologic Malignancies.
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CAR-T 细胞治疗后的 dAEs 常见，但多为低级别，且通常在输注后第 1 个月内出现。
CD19 CAR-T 细胞疗法是B细胞非霍奇金淋巴瘤（B-NHL）和急性淋巴细胞白血病（ALL）治疗的一项重要进展。本研究描述治疗后皮肤不良事件（dAE）的发生率、起病时间和相关因素。
研究者回顾性分析了纪念斯隆凯特琳癌症中心2013年4月至2020年8月接受CD19 CAR-T 细胞治疗的193例患者，旨在描述治疗后dAE，包括100天累积发生率、起病时间，以及其与细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS）的关系。
82例患者在治疗后100天内发生94起dAE，发生率为0.42（95%置信区间0.36–0.51）。常见dAE包括皮疹（30.9%，29例），其中有斑丘疹、炎性丘疹和局部红斑；感染（23.4%，22例），包括蜂窝织炎和毛囊炎；以及皮肤干燥（16.0%，15例）。较早发生的dAE包括皮疹和化疗相关事件，如脱发、黏膜炎，中位起病时间分别为输注后12天和17天。血小板减少性紫癜和皮肤干燥出现较晚，中位时间分别为22天和25天。33.5%的患者同时发生CRS和dAE，其中86%的病例先出现CRS。15%的患者发生ICANS并伴有dAE，其中67%的病例ICANS先于dAE。
CAR-T 治疗后的dAE较常见，但多数为低级别，且往往在输注后首月内出现。
CD19 CAR T-cell therapy is a significant advance in B-NHL and ALL. This study describes the incidence, onset, and factors of dermatologic adverse events (dAE) post-therapy.
A retrospective analysis at Memorial Sloan Kettering Cancer Center (4/2013-8/2020) identified 193 patients undergoing CD19 CAR T-cell therapy. We aimed to characterize dAEs post CAR T-cell therapy including the 100-day cumulative incidence, time to dAE onset, and associations with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
Eighty-two patients experienced 94 dAEs within the first 100 days (incidence: 0.42 (95% CI: 0.36-0.51) post CAR T-cell therapy. Common dAEs were rash (30.9%, n = 29) including maculopapular rash, inflammatory papules, and local erythema; infection (23.4%, n = 22) including cellulitis and folliculitis; and xerosis (16.0%, n = 15). Specific early onset dAEs included rash and chemotherapy-related events, eg, alopecia, mucositis (median 12- and 17-days postinfusion, respectively). Thrombocytopenic purpura and xerosis presented later (median 22-and 25-days). CRS and dAEs occurred in 33.5% of patients, with CRS preceding dAEs in 86% of cases. Among 15% with ICANS and dAEs, ICANS was antecedent in 67%.
dAEs following CAR T-cell therapy are common but mostly low-grade and often manifest within the initial month postinfusion.
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