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
输注时低网织红细胞计数是 CAR-T 细胞治疗中高级别细胞因子释放综合征的危险因素
英文原题：Low reticulocyte count at infusion is a risk factor for high-grade cytokine release syndrome in chimeric antigen receptor T cell therapy.
查看英文原题
Low reticulocyte count at infusion is a risk factor for high-grade cytokine release syndrome in chimeric antigen receptor T cell therapy.
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中文摘要
尽管嵌合抗原受体（CAR）-T细胞疗法对B细胞淋巴瘤高度有效，但其常引起细胞因子释放综合征（CRS）。高级别CRS较为严重，可能需要重症监护，然而可靠的早期预测标志物仍难以确定。为识别高级别CRS的危险因素，我们回顾性分析了接受CD19 CAR-T 细胞治疗的B细胞淋巴瘤患者。在分析的106例患者中，93例（88%）发生CRS，28例（26%）为2级CRS，6例（6%）为3级CRS。发生2级CRS的患者在输注时的网织红细胞计数显著较低（1.85 vs. 2.80 10 4 / L，p = 0.02）。
多变量分析确定低网织红细胞计数（< 15,000/ L；HR 2.21；95% CI 1.01-4.86；p = 0.048）、高代谢肿瘤体积（> 100 mL）以及使用axicabtagene ciloleucel是2级CRS的独立危险因素。按网织红细胞截断值进行分层显示，低计数患者的30天CRS累积发生率更高，无论是2级（42.9% vs. 19.7%，p = 0.012）还是3级CRS（17.9% vs. 1.3%，p < 0.001）。KyoTox-CRS是一个整合这些因素的风险评分系统，可有效对这些CRS风险进行分层。基于输注时网织红细胞计数对高级别CRS进行早期预测，可能有助于指导CAR-T 细胞治疗基于风险的最佳管理。
展开英文摘要原文
Although chimeric antigen receptor (CAR)-T cell therapies are highly effective for B-cell lymphoma, they frequently cause cytokine release syndrome (CRS). High-grade CRS is serious and may require intensive care, yet reliable early predictive markers remain elusive. To identify risk factors for high-grade CRS, we retrospectively analyzed B-cell lymphoma patients who received CD19 CAR-T cell therapy. Of 106 patients analyzed, CRS occurred in 93 (88%), Grade 2 CRS in 28 (26%), and Grade 3 CRS in 6 (6%). Reticulocyte counts at infusion were significantly lower in patients who developed Grade 2 CRS (1. 85 vs. 2. 80 10 4 / L, p = 0. 02).
Multivariate analysis identified low reticulocyte count (< 15,000/ L; HR 2. 21; 95% CI 1. 01-4. 86; p = 0. 048), high metabolic tumor volume (> 100 mL), and use of axicabtagene ciloleucel as independent risk factors for Grade 2 CRS. Stratification by the reticulocyte cutoff showed higher 30-day cumulative incidence of CRS in patients with low counts, for both Grade 2 (42.
9% vs. 19. 7%, p = 0. 012) and Grade 3 CRS (17. 9% vs. 1. 3%, p < 0. 001). KyoTox-CRS, a risk-scoring system integrating these factors, effectively stratified these CRS risks. Early prediction of high-grade CRS based on the reticulocyte count at infusion may help to guide optimal risk-based management of CAR-T cell therapy.
论文信息
- 作者
- Tashiro Y、Jo T、Kitawaki T、Yoshinaga N、Sakamoto T、Shirakawa K、Kanda J、Nishikori M
- 第一作者单位
- Department of Hematology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.Japan
- 通讯作者单位
- Department of Hematology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. tjoh@kuhp.kyoto-u.ac.jp.Japan
- 期刊
- International journal of hematology2026 Mar
- 原文标识
- PubMed 41247641 · DOI 10.1007/s12185-025-04109-7
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