肿瘤细胞治疗研究
英文原题：CAR-T cell therapy-associated coagulopathy: From immunothrombotic storm mechanisms to precision management strategies.
CAR-T 细胞疗法已改变了复发或难治性血液系统恶性肿瘤的治疗格局，但其获益受到免疫介导的血管毒性的限制。
CAR-T 细胞疗法已改变复发或难治性血液系统恶性肿瘤的治疗格局，但其获益受到免疫介导的血管毒性的限制。CAR-T 相关凝血病（CARAC）是一种被低估、可能致命的综合征，由内皮激活、细胞因子放大和纤溶紊乱驱动。在本综述中，我们综合了关于 CARAC 病理生物学的现有证据，强调其从早期促凝内皮转化向继发性高纤溶和消耗性凝血病的动态转变。我们描述了疾病特异性表型，包括易出血的 B 细胞急性淋巴细胞白血病、易血栓的大 B 细胞淋巴瘤以及受检测方法干扰的多发性骨髓瘤，并强调了关键诊断陷阱，如托珠单抗相关的纤维蛋白原下降。为支持标准化，我们提出一个分期适应的概念框架，整合实验室动力学、临床事件和功能性凝血评估。最后，我们概述了精准管理策略，涵盖风险适应抗凝、止血抢救以及针对迟发性炎症和内皮并发症的靶向治疗。
Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the management of relapsed or refractory hematologic malignancies, yet its benefit is constrained by immune-mediated vascular toxicities. CAR-T-associated coagulopathy (CARAC) is an under-recognized, potentially fatal syndrome driven by endothelial activation, cytokine amplification and disordered fibrinolysis. In this review, we synthesize current evidence on CARAC pathobiology, emphasizing its dynamic transition from early procoagulant endothelial conversion to secondary hyperfibrinolysis and consumptive coagulopathy. We delineate disease-specific phenotypes, including hemorrhage-prone B-cell acute lymphoblastic leukemia, thrombotic large B-cell lymphoma and assay-confounded multiple myeloma, and highlight key diagnostic pitfalls such as tocilizumab-associated fibrinogen decline. To support standardization, we propose a phase-adapted conceptual framework integrating laboratory kinetics, clinical events and functional coagulation assessment. Finally, we outline precision management strategies spanning risk-adapted anticoagulation, hemostatic rescue and targeted treatment of delayed inflammatory and endothelial complications.
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