Testa Ugo, Castelli Germana, Pelosi Elvira, Galli Eugenio, Chiusolo Patrizia
Department of Oncology, Istituto Superiore di Sanità, ROME, Italy.
Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
Mediterr J Hematol Infect Dis. 2025 May 1;17(1):e2025039. doi: 10.4084/MJHID.2025.039. eCollection 2025.
Chimeric antigen receptor (CAR) T-cell therapy has improved the outcomes of patients with relapsed/refractory B-cell lymphomas, B-cell acute lymphoblastic leukemia, and multiple myeloma. However, CAR-T cell therapy is also associated with distinct toxicities that contribute to morbidity and mortality. A large number of studies now define the different toxicities associated with CAR-T cell therapy and have, in part, clarified their mechanisms. In particular, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are the two main acute toxicity events that occur after CAR-T cell infusion. Other CAR-T-related toxicities occur later after CAR-T cell infusion and include B-cell aplasia, hypogammaglobulinemia, infections, and cytopenias. Infections represent the main cause of non-relapse death observed in patients undergoing CAR-T cell therapy. Second primary malignancies are rare and are mainly represented by myeloid malignancies.
嵌合抗原受体（CAR）T细胞疗法改善了复发/难治性B细胞淋巴瘤、B细胞急性淋巴细胞白血病和多发性骨髓瘤患者的治疗效果。然而，CAR-T细胞疗法也伴随着明显的毒性反应，这些毒性反应会导致发病和死亡。现在大量研究明确了与CAR-T细胞疗法相关的不同毒性反应，并在一定程度上阐明了其机制。特别是，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）是CAR-T细胞输注后发生的两个主要急性毒性事件。其他与CAR-T相关的毒性反应在CAR-T细胞输注后较晚出现，包括B细胞发育不全、低丙种球蛋白血症、感染和血细胞减少。感染是接受CAR-T细胞治疗患者非复发死亡的主要原因。第二原发性恶性肿瘤很少见，主要为髓系恶性肿瘤。
