Zhu H Y, Zhao D Q, Zhuang Z, Ruan J, Chen C, Zhang W, Zhou D B, Zhang Y
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing100730, China.
Zhonghua Nei Ke Za Zhi. 2024 Dec 1;63(12):1238-1245. doi: 10.3760/cma.j.cn112138-20240713-00450.
To investigate the clinical features and prognosis of prolonged cytopenia (PC) in patients with large B-cell lymphoma (LBCL) undergoing anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy. A retrospective case series study was conducted on LBCL patients who received CAR-T cell therapy with a survival time of over one month at the Hematology Department of Peking Union Medical College Hospital from March 2019 to December 2023. Statistical analyses were performed on hematologic changes at 1, 3, 6, and 12 months post-CAR-T infusion, as well as on the progression-free survival (PFS) and post-treatment adverse events, including infections. Patients were categorized into the PC and non-PC groups based on the occurrence of cytopenia at 90 days post-infusion. Differences between groups were compared, and univariate logistic regression analysis was used to identify risk factors. The median age of 27 LBCL patients receiving CAR-T cell therapy was 58 years (range 27-69 years), with 18 males. Among the 27 LBCL patients who received CAR-T cell therapy, PC was observed in 19 patients (70.4%), with instances of neutropenia (48.1%, 13 cases), anemia (37.0%, 10 cases), and thrombocytopenia (22.2%, 6 cases). Univariate logistic regression analysis revealed that prior chemotherapy sensitivity (=18.00, 95% 1.56-207.45, =0.020) and bone marrow suppression (=18.00, 95% 1.38-235.69, =0.028) were associated with PC. The median follow-up time was 13.5 months. The PC group exhibited a higher risk of infection within 3 months (9/19 vs. 1/8) and a shorter mean PFS (19.3 months vs. 24.4 months), although the difference was not statistically significant (both >0.05). PC is common following CAR-T cell therapy and is associated with an increased risk of infection and poorer prognosis. Prior treatment sensitivity and bone marrow suppression may serve as indicators of PC.
为研究接受抗CD19嵌合抗原受体T（CAR-T）细胞治疗的大B细胞淋巴瘤（LBCL）患者中持续性血细胞减少（PC）的临床特征及预后。对2019年3月至2023年12月在北京协和医院血液科接受CAR-T细胞治疗且生存时间超过1个月的LBCL患者进行回顾性病例系列研究。对CAR-T输注后1、3、6和12个月时的血液学变化、无进展生存期（PFS）以及包括感染在内的治疗后不良事件进行统计分析。根据输注后90天时血细胞减少的发生情况将患者分为PC组和非PC组。比较组间差异，并采用单因素逻辑回归分析确定危险因素。27例接受CAR-T细胞治疗的LBCL患者的中位年龄为58岁（范围27 - 69岁），其中男性18例。在27例接受CAR-T细胞治疗的LBCL患者中，19例（70.4%）观察到PC，其中中性粒细胞减少13例（48.1%）、贫血10例（37.0%）、血小板减少6例（22.2%）。单因素逻辑回归分析显示，既往化疗敏感性（=18.00，95% 1.56 - 207.45，=0.020）和骨髓抑制（=18.00，95% 1.38 - 235.69，=0.028）与PC相关。中位随访时间为13.5个月。PC组在3个月内感染风险较高（9/19 vs. 1/8），平均PFS较短（19.3个月vs. 24.4个月），尽管差异无统计学意义（均>0.05）。PC在CAR-T细胞治疗后很常见，且与感染风险增加和预后较差相关。既往治疗敏感性和骨髓抑制可能作为PC的指标。
