血液学参数与白蛋白在靶向 BCMA 的 CAR-T 治疗多发性骨髓瘤中的预后意义

Multiple myeloma is an incurable hematologic malignancy, and CAR-T therapy can benefit some patients with relapsed or refractory disease.

However, due to individual variations, treatment outcomes vary significantly among different patients.

We retrospectively analyzed 77 relapsed/refractory MM patients receiving BCMA-targeted CAR-T therapy. Baseline and dynamic hematological/nutritional parameters were assessed at four time points: prior to CAR-T cell collection, before pre-lymphodepletion therapy, before CAR-T cell infusion, and within the 7-day post-infusion. Prognostic groups were stratified by progression-free survival (PFS 10 vs. > 10 months). The results demonstrate that patients in the poor prognosis group consistently exhibited significantly lower levels of HGB, RBC, and HCT throughout the treatment period(p<0. 05). Before pre-lymphodepletion ALB level in the poor prognosis group was significantly lower than that in the good prognosis group (p<0.

05). LDH, creatinine, calcium ions, and 2-microglobulin showed no differences at the four observation time points(p>0. 05). ROC analysis confirmed prognostic value for HGB (AUC = 0. 693), RBC (AUC = 0. 669), HCT (AUC = 0. 691), and ALB (AUC = 0. 756) (all p < 0. 05). Kaplan-Meier analysis linked low HGB ( 92. 5 g/L), RBC ( 3. 26 10 /L), HCT ( 32.

05%), and ALB ( 35. 3 g/L) to inferior PFS (p = 0. 011, 0. 014, 0. 0033, and 0. 0001, respectively). Low ALB ( 35. 3 g/L) before pre-lymphodepletion is a practical biomarker for risk stratification, reflecting compromised bone marrow reserve and immune-nutritional status. These accessible parameters may optimize patient selection and supportive care strategies.