Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China.
Shanghai Genbase Biotechnology Co., Ltd, Shanghai, China.
Cancer Med. 2024 Feb;13(4):e7064. doi: 10.1002/cam4.7064.
Although anti-CD19 chimeric antigen receptor (CAR) T cell therapy was approved as a very effective salvage strategy in relapsed/refractory (R/R) B cell lymphoma, the experience in R/R gastrointestinal (GI) lymphoma is still insufficient.
We summarized the efficacy and side effects of anti-CD19 CAR T-cell therapy in 12 patients with R/R GI lymphoma. Based on literature, the R/R GI lymphoma patients were divided into subgroups with different characteristics: Bulky/No bulky disease, Gastric/Gastrointestinal involvement, Gastrointestinal/Combined extra-gastrointestinal lesions, Ulcer/Lumps or nodules type, With/without gastrointestinal bleeding.
The objective response rate (ORR) was 66.67% in these 12 patients. The ORR was 83.33% in no bulky disease group, 80.00% in gastric involvement group, 100.00% in ulcer type group, and 80.00% in no gastrointestinal bleeding group. The CR rate was 33.33% in these 12 patients. The CR was 50.0% in no bulky disease group, 60.00% in gastric involvement group, and 80.00% in ulcer type group. The PFS and OS rate of the 12 patients at 6 months after infusion were 54.55% and 58.33%, respectively. The overall survival (OS) at 6 months was higher in no bulky disease group. There was no difference of the OS or the progression free survival (PFS) at 6 months between the other groups. The mean peak of CAR-T cells and Cytokine Release Syndrome (CRS) grade were higher in gastrointestinal lesions group. The mean peak of IFN-γ and CRS grade were higher in gastrointestinal bleeding group. Four out of six patients in group of gastrointestinal lesions group were patient with high tumor burden. Patients with gastrointestinal involvement only were at higher risk for gastrointestinal bleeding.
The ORR and CR of high tumor load, gastrointestinal involvement, lumps or nodules type and gastrointestinal bleeding group were lower. The CRS grade was higher in gastrointestinal lesions group and in gastrointestinal bleeding group. Patients with gastrointestinal involvement only were at higher risk for gastrointestinal bleeding.
尽管抗 CD19 嵌合抗原受体（CAR）T 细胞疗法已被批准作为复发/难治性（R/R）B 细胞淋巴瘤的非常有效的挽救策略，但在复发/难治性胃肠道（GI）淋巴瘤中的经验仍然不足。
我们总结了 12 例 R/R 胃肠道淋巴瘤患者接受抗 CD19 CAR-T 细胞治疗的疗效和副作用。根据文献，将 R/R GI 淋巴瘤患者分为具有不同特征的亚组：肿块/无肿块疾病、胃/胃肠道受累、胃肠道/联合胃肠外病变、溃疡/肿块或结节型、有/无胃肠道出血。
这 12 例患者的客观缓解率（ORR）为 66.67%。无肿块疾病组的 ORR 为 83.33%，胃受累组为 80.00%，溃疡型组为 100.00%，无胃肠道出血组为 80.00%。这 12 例患者的完全缓解率（CR）为 33.33%。无肿块疾病组的 CR 为 50.0%，胃受累组的 CR 为 60.00%，溃疡型组的 CR 为 80.00%。输注后 6 个月时 12 例患者的 PFS 和 OS 率分别为 54.55%和 58.33%。无肿块疾病组的总生存（OS）在 6 个月时更高。其他组之间 6 个月时的 OS 或无进展生存期（PFS）没有差异。胃肠道病变组的 CAR-T 细胞和细胞因子释放综合征（CRS）的平均峰值更高。有胃肠道出血的组中 IFN-γ和 CRS 等级的平均峰值更高。胃肠道病变组的 6 例患者中有 4 例患者肿瘤负荷较高。仅胃肠道受累的患者发生胃肠道出血的风险更高。
高肿瘤负荷、胃肠道受累、肿块或结节型和胃肠道出血组的 ORR 和 CR 较低。胃肠道病变组和胃肠道出血组的 CRS 分级较高。仅胃肠道受累的患者发生胃肠道出血的风险更高。
