CAR T 细胞治疗淋巴瘤患者中预输注肿瘤生长率对 CRS 和 ICANS 发生和严重程度的预测价值。
Predictive value of pre-infusion tumor growth rate for the occurrence and severity of CRS and ICANS in lymphoma under CAR T-cell therapy.
机构信息
Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany.
出版信息
Ann Hematol. 2024 Jan;103(1):259-268. doi: 10.1007/s00277-023-05507-9. Epub 2023 Oct 20.
Chimeric antigen receptor T-cell therapy (CART) can be administered outpatient yet requires management of potential side effects such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The pre-infusion tumor burden is associated with CRS, yet there is no data on the relevance of pre-infusion tumor growth rate (TGR). Our objective was to investigate TGR for the occurrence and severity of CRS and ICANS. Consecutive patients with available pre-baseline and baseline (BL) imaging before CART were included. TGR was determined as both absolute (abs) and percentage change (%) of Lugano criteria-based tumor burden in relation to days between exams. CRS and ICANS were graded according to ASTCT consensus criteria. Clinical metadata was collected including the international prognostic index (IPI), patient age, ECOG performance status, and LDH. Sixty-two patients were included (median age: 62 years, 40% female). The median pre-BL TGR [abs] and pre-BL TGR [%] was 7.5 mm/d and 30.9%/d. Pre-BL TGR [abs] and pre-BL TGR [%] displayed a very weak positive correlation with the grade of CRS (r[abs] = 0.14 and r[%] = 0.13) and no correlation with ICANS (r[abs] = - 0.06 and r[%] = - 0.07). There was a weak positive correlation between grade of CRS and grade of ICANS (r = 0.35; p = 0.005) whereas there was no significant correlation of CRS or ICANS to any other of the examined parameters. The pre-infusion TGR before CART was weakly associated with the occurrence of CRS, but not the severity, whereas there were no significant differences in the prediction of ICANS. There was no added information when compared to pre-infusion tumor burden alone. Outpatient planning and toxicity management should not be influenced by the pre-infusion TGR.
嵌合抗原受体 T 细胞疗法 (CART) 可在门诊进行,但需要管理潜在的副作用,如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)。输注前肿瘤负荷与 CRS 相关,但尚无关于输注前肿瘤生长率 (TGR) 相关性的数据。我们的目的是研究 TGR 与 CRS 和 ICANS 的发生和严重程度的关系。纳入了连续的患者,这些患者在 CART 之前有可获得的基线 (BL) 前和基线 (BL) 影像学检查。TGR 是通过 Lugano 标准为基础的肿瘤负荷的绝对值 (abs) 和百分比变化 (%) 相对于检查之间的天数来确定的。CRS 和 ICANS 根据 ASTCT 共识标准进行分级。收集了临床元数据,包括国际预后指数 (IPI)、患者年龄、ECOG 表现状态和 LDH。共纳入 62 例患者(中位年龄:62 岁,40%为女性)。BL 前 TGR[abs]和 BL 前 TGR [%]分别为 7.5mm/d 和 30.9%/d。BL 前 TGR[abs]和 BL 前 TGR [%]与 CRS 分级呈弱正相关(r[abs] = 0.14 和 r[%] = 0.13),与 ICANS 无相关性(r[abs] = -0.06 和 r[%] = -0.07)。CRS 分级与 ICANS 分级呈弱正相关(r = 0.35;p = 0.005),而 CRS 或 ICANS 与其他检查参数无显著相关性。CART 前 TGR 与 CRS 的发生有弱相关性,但与严重程度无关,而对 ICANS 的预测无显著差异。与单独的输注前肿瘤负荷相比,没有提供更多的信息。门诊计划和毒性管理不应受输注前 TGR 的影响。