Perthus Alya, Colin Fanny, Charton Emilie, Anota Amélie, Lhomme Faustine, Manson Guillaume, De Guibert Sophie, Daufresne Pierre, Bellec Adeline, Le Bars Laetitia, De Barros Sandra, Ysebaert Loïc, Merceur Marianne, Cogné Mélanie, Lamy De La Chapelle Thierry, Houot Roch, Moignet Aline
Service d'Hématologie-CHU Pontchaillou, Department of Hematology University Hospital of Rennes Rennes France.
Human and Social Sciences Department Leon Berard Center Lyon France.
Hemasphere. 2024 May 27;8(5):e72. doi: 10.1002/hem3.72. eCollection 2024 May.
Chimeric antigen receptor T cells (CAR T cells) can induce prolonged remission in a substantial subset of patients with relapse/refractory lymphoma. However, little is known about patients' life after CAR T-cell therapy. We prospectively assessed the multidimensional recovery of lymphoma patients in remission, before leukapheresis, before CAR T-cell infusion, and 3, 6, and 12 months thereafter. Validated tools were used to measure lymphoma-related and global health-related quality of life (HRQoL; Functional Assessment of Cancer Therapy-Lymphoma [FACT-Lym] and EQ-5D-5L), cognitive complaint (FACT-Cognition), fatigue (FACIT-Fatigue subscale), psychological status (Hospital Anxiety and Depression Scale, Post-Traumatic Check List Scale), and sexuality (Relationship and Sexuality Scale). Beyond 12 months of remission, we also surveyed physical, professional, sexual, and general life status. At 3, 6, and 12 months, 53, 35, and 23 patients were evaluable, respectively. Improvement in lymphoma-related HRQoL was clinically relevant at 3, 6, and 12 months with a mean change from baseline of 10.9 (95% confidence interval [CI]: 5.8; 16.1), 12.2 (95% CI: 4.2; 20.1), and 11.72 (95% CI: 2.06; 21.38), respectively. Improvement in global HRQoL, fatigue, and anxiety was clinically relevant, but 20%-40% of patients experienced persistent fatigue, psychological distress, and cognitive complaints over time. Beyond 12 months after CAR T cells, 81.8% of 22 evaluable patients were satisfied with their daily life. Physical activity, professional, sexual, and global well-being had returned to prediagnosis levels in nearly half of the patients. We found an improvement in HRQoL after CAR T-cell therapy including anxiety, depression, sexual satisfaction, and general well-being. However, not all patients recover a "normal life." Further research is needed to determine which patients are at risk of quality-of-life impairment to improve recovery after CAR T-cell infusion.
嵌合抗原受体T细胞（CAR-T细胞）可使相当一部分复发/难治性淋巴瘤患者获得长期缓解。然而，对于接受CAR-T细胞治疗后患者的生活情况知之甚少。我们前瞻性地评估了淋巴瘤缓解期患者在白细胞分离术前、CAR-T细胞输注前以及输注后3个月、6个月和12个月的多维度恢复情况。使用经过验证的工具来测量与淋巴瘤相关的以及与整体健康相关的生活质量（HRQoL；癌症治疗功能评估-淋巴瘤[FACT-Lym]和EQ-5D-5L）、认知主诉（FACT-认知）、疲劳（FACIT-疲劳子量表）、心理状态（医院焦虑抑郁量表、创伤后检查表量表）和性功能（关系与性量表）。在缓解超过12个月后，我们还调查了患者的身体、职业、性和总体生活状况。在3个月、6个月和12个月时，分别有53例、35例和23例患者可进行评估。在3个月、6个月和12个月时，与淋巴瘤相关的HRQoL改善具有临床意义，与基线相比的平均变化分别为10.9（95%置信区间[CI]：5.8；16.1）、12.2（95%CI：4.2；20.1）和11.72（95%CI：2.06；21.38）。整体HRQoL、疲劳和焦虑的改善具有临床意义，但随着时间的推移，20%-40%的患者仍存在持续疲劳、心理困扰和认知主诉。在CAR-T细胞治疗12个月后，22例可评估患者中有81.8%对其日常生活感到满意。近一半的患者身体活动、职业、性功能和整体幸福感已恢复到诊断前水平。我们发现CAR-T细胞治疗后HRQoL有所改善，包括焦虑、抑郁、性满意度和整体幸福感。然而，并非所有患者都能恢复“正常生活”。需要进一步研究以确定哪些患者存在生活质量受损的风险，从而改善CAR-T细胞输注后的恢复情况。
