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
年龄对 CD19 CAR-T 细胞治疗大 B 细胞淋巴瘤后结局的影响
英文原题：Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas.
查看英文原题
Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas.
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中文摘要
年龄可能影响CD19靶向嵌合抗原受体（CAR）T细胞（CAR-T）治疗后的临床结局。关于接受CAR-T 治疗的老年患者生存和毒性结局的真实世界数据有限。
我们使用了国际血液和骨髓移植研究中心的数据，纳入2018年5月至2020年6月期间接受CAR-T 治疗的成人弥漫性大B细胞淋巴瘤患者。报告了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）的累积发生率和严重程度。以年龄作为连续变量并在4个年龄组中评估疗效和安全性结局：18至54岁、55至64岁、65至74岁和75岁。在1916例总受者中，近一半（44%）年龄65岁。患者接受axicabtagene ciloleucel（75%）或tisagenlecleucel（25%）。CRS和ICANS的总体发生率分别为75%和43%，CRS和ICANS的严重发生率分别为9%和21%。
对于所有患者，12个月总生存期（OS）、无进展生存期（PFS）和复发率分别为62%、42%和55%。作为连续变量，年龄较大不影响OS、PFS和CRS；然而，ICANS风险随年龄增加（风险比[HR]，1.03；P < .001）。在年龄>64岁时，ICANS风险增加（HR，1.65；95%置信区间（CI），1.33-2.1；P < .001）。在分类分析中，65至74岁年龄组的复发风险低于年轻患者（HR，0.77；95% CI，0.64-0.93；P = .005）。CD19 CAR-T 治疗对老年人有效，年龄较大不会增加死亡率。年龄较大与较高的ICANS风险相关，应指导患者选择。
展开英文摘要原文
Age may influence clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy. Real-world data on the survival and toxicity outcomes of older patients receiving CAR-T therapy are limited.
We used data from the Center for International Blood and Marrow Transplant Research for adults with diffuse large B-cell lymphoma who received CAR-T therapy from May 2018 to June 2020. Cumulative incidence and severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were reported.
Efficacy and safety outcomes were assessed using age as a continuous variable and among 4 age groups: 18 to 54, 55 to 64, 65 to 74, and 75 years. Nearly half (44%) of 1916 total recipients were aged 65 years. Patients received either axicabtagene ciloleucel (75%) or tisagenlecleucel (25%).
Overall rates of CRS and ICANS were 75% and 43%, and severe rates of CRS and ICANS were 9% and 21%, respectively. For all patients, 12-month overall survival (OS), progression-free survival (PFS), and relapse rates were 62%, 42%, and 55%, respectively. As a continuous variable, older age did not affect OS, PFS, and CRS; however, the risk of ICANS increased with age (hazard ratio [HR], 1. 03; P < . 001).
At age >64 years, risk for ICANS increases (HR, 1. 65;95% confidence interval (CI), 1. 33-2. 1; P < . 001). In a categorical analysis, the 65 to 74-year age group had lower relapse risk (HR, 0. 77;95% CI, 0. 64-0. 93; P = . 005) than younger patients. CD19 CAR-T therapy is effective for older adults, and older age does not worsen mortality. Older age is associated with higher ICANS risk and should guide patient selection.
论文信息
- 作者
- Mirza AS、Hosing C、Foss F、Kim S、Moskop A、Oloyede T、Abid MB、Afrough A
- 第一作者单位
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL.United States
- 通讯作者单位
- Section of Hematology and Bone Marrow Transplantation, Yale Cancer Center and Yale School of Medicine, New Haven, CT.
- 期刊
- Blood neoplasia2026 May
- 原文标识
- PubMed 41867486 · DOI 10.1016/j.bneo.2025.100187
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