Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA.
Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA.
Blood Adv. 2023 Mar 28;7(6):1001-1010. doi: 10.1182/bloodadvances.2022008119.
There is a need for biomarkers to predict and measure the severity of immune effector cell-associated neurotoxicity syndrome (ICANS). Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) are well-validated biomarkers of astroglial and neuronal injury, respectively. We hypothesized that pretreatment GFAP and NfL levels can predict the risk of subsequent ICANS and that increases in GFAP and NfL levels during treatment reflect ICANS severity. We measured cerebrospinal fluid GFAP (cGFAP) and NfL (cNfL) along with serum NfL (sNfL) levels at pretreatment and day 7 to 10 after chimeric antigen receptor (CAR) T-cell infusion in 3 pediatric cohorts treated with CD19- or CD19/CD22-directed CAR T cells. cGFAP and cNfL levels increased during grade ≥1 ICANS in patients treated with CD19-directed CAR T cells but not in those who received CD19/CD22-directed CAR T cells. The sNfL levels did not increase during ICANS. Prelymphodepletion cGFAP, cNfL, and sNfL levels were not predictive of subsequent ICANS. Elevated baseline cGFAP levels were associated with a history of transplantation. Patients with prior central nervous system (CNS) radiation had higher cNfL levels, and elevated baseline sNfL levels were associated with a history of peripheral neuropathy. Thus, cGFAP and cNfL may be useful biomarkers for measuring the severity of CNS injury during ICANS in children. Elevated baseline levels of cGFAP, cNfL, and sNfL likely reflect the cumulative injury to the central and peripheral nervous systems from prior treatment. However, levels of any of the 3 biomarkers before CAR T-cell infusion did not predict the risk of ICANS.
需要生物标志物来预测和衡量免疫效应细胞相关神经毒性综合征 (ICANS) 的严重程度。胶质纤维酸性蛋白 (GFAP) 和神经丝轻链 (NfL) 分别是星形胶质细胞和神经元损伤的经过充分验证的生物标志物。我们假设预处理 GFAP 和 NfL 水平可以预测随后发生 ICANS 的风险,并且治疗过程中 GFAP 和 NfL 水平的升高反映了 ICANS 的严重程度。我们在 3 个儿科队列中测量了接受 CD19 或 CD19/CD22 定向嵌合抗原受体 (CAR) T 细胞治疗的患者在 CAR T 细胞输注前和输注后第 7 至 10 天的脑脊液 GFAP (cGFAP) 和 NfL (cNfL) 以及血清 NfL (sNfL) 水平,这些患者患有 ICANS 级别≥1。在接受 CD19 定向 CAR T 细胞治疗的患者中,cGFAP 和 cNfL 水平在发生≥1 级 ICANS 期间升高,但在接受 CD19/CD22 定向 CAR T 细胞治疗的患者中则没有升高。sNfL 水平在 ICANS 期间没有升高。淋巴细胞耗竭前 cGFAP、cNfL 和 sNfL 水平不能预测随后发生的 ICANS。升高的基线 cGFAP 水平与移植史相关。有中枢神经系统 (CNS) 放疗史的患者 cNfL 水平较高,而基线 sNfL 水平升高与周围神经病史相关。因此,cGFAP 和 cNfL 可能是衡量儿童 ICANS 期间 CNS 损伤严重程度的有用生物标志物。升高的基线 cGFAP、cNfL 和 sNfL 水平可能反映了先前治疗对中枢和周围神经系统的累积损伤。然而,CAR T 细胞输注前任何一种生物标志物的水平都不能预测 ICANS 的风险。
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