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.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
住院 CAR-T 细胞治疗受者中巨细胞病毒感染与临床结局
英文原题：Cytomegalovirus Infection and Clinical Outcomes in Hospitalized Chimeric Antigen Receptor T-Cell Therapy Recipients.
查看英文原题
Cytomegalovirus Infection and Clinical Outcomes in Hospitalized Chimeric Antigen Receptor T-Cell Therapy Recipients.
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研究概要
CAR-T 受者中的 CMV 感染与院内死亡率升高、住院时间延长以及脑病风险增高相关。
中文摘要
**背景：**CAR-T（CAR-T）细胞疗法革新了血液系统恶性肿瘤管理，但也伴有显著毒性，包括巨细胞病毒（CMV）等机会性感染。目前关于CMV感染对CAR-T 受者临床影响的证据有限。
本研究评估该人群CMV感染相关结局。**方法：**研究利用2021年医疗费用与利用项目—全国再入院数据库（HCUP-NRD）开展回顾性队列分析，纳入因CAR-T 治疗多发性骨髓瘤、非霍奇金淋巴瘤或急性白血病而住院的成人。采用倾向评分匹配平衡基线特征，并在R软件中进行加权分析，比较CMV阳性和阴性组结局。**结果：**1,806次住院中，索引住院期间2.2%的患者发生CMV感染。匹配队列中，CMV组院内死亡率为10.3%，非CMV组为2.6%（风险比RR=3.9，95% CI 0.46–33.3；P=0.36）。
CMV感染与住院时间显著延长相关（41.5比15.9天；校正比值1.67，95% CI 1.27–2.19；P<0.01），并增加脑病风险（RR=13.21，95% CI 1.66–105.2；P=0.015）。细胞因子释放综合征、肿瘤溶解综合征、急性肾损伤及输血需求等其他并发症差异无统计学显著性。CAR-T 治疗后3个月内因CMV感染住院的累积发生率为4.2%。CMV患者3个月死亡率显著高于非CMV患者（15.8%比2.5%；RR=6.32，95% CI 1.46–27.3；P=0.004）。**结论：**CAR-T 受者发生CMV感染与院内死亡率升高、住院时间延长及脑病风险增加相关。研究结果凸显在这一高危人群中密切监测CMV并尽早处理的重要性。
展开英文摘要原文
BACKGROUND
Chimeric antigen receptor T (CAR-T) cell therapy has revolutionized the management of hematologic malignancies but is associated with significant toxicities, including opportunistic infections such as cytomegalovirus (CMV). Limited evidence exists regarding the clinical impact of CMV in CAR-T recipients. This study evaluated outcomes associated with CMV infection in this population.
METHODS
A retrospective cohort study was conducted using the 2021 Healthcare Cost and Utilization Project-National Readmissions Database (HCUP-NRD). Adult patients hospitalized for CAR-T therapy for multiple myeloma, non-Hodgkin lymphoma, or acute leukemia were included. Propensity score matching was applied to balance baseline characteristics, and weighted analyses were conducted in R software (R Foundation for Statistical Computing, Vienna, Austria) to compare outcomes between CMV-positive and CMV-negative groups.
RESULTS
Among 1,806 hospitalizations, CMV infection was identified in 2.2% of patients during the index admission. In the matched cohort, in-hospital mortality in the CMV group compared with non-CMV patients (10.3% vs. 2.6%; risk ratio (RR) 3.9, 95% CI: 0.46-33.3; p = 0.36). CMV infection was associated with significantly longer length of stay (41.5 vs. 15.9 days; adjusted ratio 1.67, 95% CI: 1.27-2.19; p < 0.01) and increased risk of encephalopathy (RR 13.21, 95% CI: 1.66-105.2; p = 0.015). Other complications, including cytokine release syndrome, tumor lysis syndrome, acute kidney injury, and transfusion requirements, did not differ significantly. At three months post-CAR-T, the cumulative incidence of patients hospitalized with CMV infection was 4.2%. Three-month mortality was significantly higher in CMV patients compared with non-CMV patients (15.8% vs. 2.5%; RR 6.32, 95% CI: 1.46-27.3; p = 0.004).
CONCLUSION
CMV infection in CAR-T recipients is associated with increased in-hospital mortality, extended hospital stays, and a higher risk of encephalopathy. These findings underscore the importance of vigilant monitoring and early management of CMV in this high-risk population.
论文信息
- 作者
- Khan MA、Shafiq M、Khan MA、Khan FH、McGuirk JP、Okut H、Ellerbeck E、Ahmed N
- 第一作者单位
- Internal Medicine, University of Kansas Medical Center, Kansas City, USA.United States
- 通讯作者单位
- Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, USA.United States
- 期刊
- Cureus2026 Jan
- 原文标识
- PubMed 41664759 · DOI 10.7759/cureus.101121
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