Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia.
Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Clinical Haematology, Peter MacCallum Cancer Centre, VIC, Australia; CORe, Department of Medicine, University of Melbourne, VIC, Australia.
J Autoimmun. 2023 Nov;140:103126. doi: 10.1016/j.jaut.2023.103126. Epub 2023 Oct 12.
This systematic review aimed to characterise the cognitive outcomes of patients who received chimeric antigen receptor T-cell therapy.
A systematic search of the literature was performed using PubMed, PsycINFO, SCOPUS, EMBASE, Medline, and CINAHL (February 2023). Risk of bias was assessed using the JBI Checklist for Case Reports and the Risk of Bias Assessment Tool for Non-randomised Studies.
Twenty-two studies met inclusion criteria with a total of 1104 participants. There was considerable methodological heterogeneity with differing study designs (e.g., cohort studies, clinical trials, case studies, a qualitative interview, and a focus group), measures of cognition (e.g., self-report, neuropsychological measures, clinician assessed/neurological examinations), and longest follow-up time points (i.e., five days to five years).
Results of the studies were heterogenous with studies demonstrating stable, improved, or reduced cognition across differing time points. Overall, cognitive symptoms are common particularly in the acute stage (<2 weeks) post-infusion. Most deficits that arise in the acute stage resolve within one to two weeks, however, there is a subset of patients who continue to experience and self-report persistent deficits in the subacute and chronic stages. Future studies are needed to comprehensively analyse cognition using a combination of self-report and psychometric measures following chimeric antigen receptor T-cell therapy in the acute, subacute, and chronic settings.
本系统评价旨在描述接受嵌合抗原受体 T 细胞治疗的患者的认知结果。
使用 PubMed、PsycINFO、SCOPUS、EMBASE、Medline 和 CINAHL（2023 年 2 月）对文献进行系统检索。使用 JBI 病例报告清单和非随机研究偏倚风险评估工具评估偏倚风险。
22 项研究符合纳入标准，共有 1104 名参与者。研究设计存在很大的方法学异质性（例如队列研究、临床试验、病例研究、定性访谈和焦点小组）、认知测量方法（例如自我报告、神经心理学测量、临床医生评估/神经学检查）和最长随访时间点（即 5 天至 5 年）。
研究结果存在异质性，研究表明在不同时间点认知稳定、改善或下降。总体而言，认知症状很常见，特别是在输注后急性阶段（<2 周）。大多数在急性阶段出现的缺陷在 1 至 2 周内得到解决，但有一部分患者在亚急性和慢性阶段继续出现并自我报告持续存在缺陷。未来的研究需要在急性、亚急性和慢性环境下，使用自我报告和心理计量学测量相结合的方法，全面分析嵌合抗原受体 T 细胞治疗后的认知情况。
