使用艾曲泊帕改善抗CD19嵌合抗原受体T细胞治疗患者的血小板减少症及输血需求
Use of Eltrombopag to Improve Thrombocytopenia and Tranfusion Requirement in Anti-CD19 CAR-T Cell-Treated Patients.
作者信息
Mingot-Castellano Maria-Eva, Reguera-Ortega Juan Luis, Zafra Torres Denis, Hernani Rafael, Lopez-Godino Oriana, Guerreiro Manuel, Herrero Blanca, López-Corral Lucia, Luna Alejandro, Gonzalez-Pinedo Lesli, Chinea-Rodriguez Anabelle, Africa-Martín Ana, Bailen Rebeca, Martinez-Cibrian Nuria, Balsalobre Pascual, Filaferro Silvia, Alonso-Saladrigues Anna, Barba Pere, Perez-Martinez Antonio, Calbacho María, Perez-Simón Jose Antonio, Sánchez-Pina Jose Maria
机构信息
Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, IBiS/CSIC, Universidad de Sevilla, 41004 Sevilla, Spain.
Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
出版信息
J Clin Med. 2024 Aug 28;13(17):5117. doi: 10.3390/jcm13175117.
Immune effector cell-associated hematotoxicity (ICAHT) is a frequent adverse event after chimeric antigen receptor (CAR)-T cell therapy. Grade ≥ 3 thrombocytopenia occurs in around one-third of patients, and many of them become platelet transfusion-dependent. Eltrombopag is a thrombopoietin receptor agonist (TPO-RA) able to accelerate megakaryopoiesis, which has been used successfully in patients with bone marrow failure and immune thrombocytopenia (ITP). Its role in managing thrombocytopenia and other cytopenias in CAR-T cell-treated patients has been scarcely addressed. Our aim was to report the safety and efficacy of this approach in patients included in the Spanish Group for Hematopoietic Transplantation and Cellular Therapy (GETH-TC) registry. This is a retrospective, multicenter, observational study. Patients who developed platelet transfusion dependence subsequently to CAR-T cells and received eltrombopag to improve platelet counts were recruited in 10 Spanish hospitals. Thirty-eight patients were enrolled and followed up for a median (interquartile range [IQR]) of 175 (99, 489) days since CAR-T cell infusion. At the moment eltrombopag was indicated, 18 patients had thrombocytopenia and another severe cytopenia, while 8 patients had severe pancytopenia. After 32 (14, 38) days on eltrombopag, 29 (76.3%) patients recovered platelet transfusion independence. The number of platelet units transfused correlated with the time needed to restore platelet counts higher than 20 × 10/L (Rho = 0.639, < 0.001). Non-responders to eltrombopag required more platelet units (58 [29, 69] vs. 12 [6, 26] in responders, = 0.002). Nineteen out of twenty-three (82.6%) patients recovered from severe neutropenia after 22 (11, 31) days on eltrombopag. Twenty-nine out of thirty-five (82.9%) patients recovered red blood cell (RBC) transfusion independence after 29 (17, 44) days. Seven patients recovered all cell lineages while on treatment. No thromboembolic events were reported. Only two transient toxicities (cholestasis, hyperbilirubinemia) were reported during eltrombopag treatment, none of which compelled permanent drug withdrawal. Eltrombopag could be safely used to manage thrombocytopenia and accelerate transfusion independence in CAR-T cell-treated patients.
免疫效应细胞相关血液毒性(ICAHT)是嵌合抗原受体(CAR)-T细胞治疗后常见的不良事件。约三分之一的患者会出现≥3级血小板减少,其中许多人变得依赖血小板输注。艾曲泊帕是一种促血小板生成素受体激动剂(TPO-RA),能够加速巨核细胞生成,已成功用于治疗骨髓衰竭和免疫性血小板减少症(ITP)患者。其在CAR-T细胞治疗患者中管理血小板减少和其他血细胞减少方面的作用鲜有研究。我们的目的是报告这种方法在西班牙造血移植和细胞治疗组(GETH-TC)登记研究中的安全性和有效性。这是一项回顾性、多中心、观察性研究。在10家西班牙医院招募了CAR-T细胞治疗后出现血小板输注依赖并接受艾曲泊帕以提高血小板计数的患者。38例患者入组,自CAR-T细胞输注后中位(四分位间距[IQR])随访175(99,489)天。在开始使用艾曲泊帕时,18例患者有血小板减少和另一种严重血细胞减少,8例患者有严重全血细胞减少。使用艾曲泊帕32(14,38)天后,29例(76.3%)患者恢复了血小板输注独立性。输注的血小板单位数量与恢复血小板计数高于20×10⁹/L所需时间相关(Rho = 0.639,P < 0.001)。艾曲泊帕治疗无效者需要更多的血小板单位(无效者为58[29,69]个,有效者为12[6,26]个,P = 0.002)。23例患者中有19例(82.6%)在使用艾曲泊帕22(11,31)天后从中性粒细胞减少症中恢复。35例患者中有29例(82.9%)在使用艾曲泊帕29(17,44)天后恢复了红细胞(RBC)输注独立性。7例患者在治疗期间所有细胞系均恢复。未报告血栓栓塞事件。在艾曲泊帕治疗期间仅报告了2例短暂毒性反应(胆汁淤积、高胆红素血症),均未导致永久停药。艾曲泊帕可安全用于管理CAR-T细胞治疗患者的血小板减少并加速输注独立性。