Stolz Sebastian M, Musa Albulena, Bachofner Adrian, Bankova Andriyana K, Gourri Elise, Manz Markus G, Rieger Max J, Schneidawind Dominik, Wolfensberger Nathan, Zenz Thorsten, Rösler Wiebke
Department of Medical Oncology and Hematology, University Hospital of Zurich, Zurich, Switzerland.
Medical Oncology and Hematology, Kantonsspital Winterthur, Winterthur, Switzerland.
Ann Hematol. 2025 Jul 25. doi: 10.1007/s00277-025-06511-x.
CAR (chimeric antigen receptor) T-cell therapies have transformed treatment for relapsed and refractory B cell lymphomas (r/r BCL) and plasma cell myeloma. While real-world experiences have shown success across age groups, patients over 70 years require special attention due to therapy-related complications like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can lead to adverse outcomes. This study analyzed outcomes of 26 r/r BCL patients aged ≥ 70 years treated with CAR T-cell therapy between 2019 and 2023, comparing those who received prophylactic Tocilizumab (N = 7) versus standard treatment (N = 19). The median age was 75 years, with patients having received a median of three prior therapy lines. Prophylactic Tocilizumab was given 1 h before re-transfusion of CAR T-cells. Patients receiving prophylactic Tocilizumab experienced significantly fewer therapy-related complications (p = 0.039) which were defined as one or more of the following events: severe CRS, severe ICANS, corticosteroid use, need for transfusions, treatment in a critical care unit, prolonged hospitalization and discharge to a care facility. Hospital stays in total were shorter in the Tocilizumab group (15.9 vs. 18.5 days), though not statistically significant. Progression-free and overall survival were similar between groups. The results suggest that prophylactic Tocilizumab may optimize management of older CAR T-cell patients, aligning with existing evidence regarding its prophylactic use in r/r BCL.
嵌合抗原受体（CAR）T细胞疗法已经改变了复发难治性B细胞淋巴瘤（r/r BCL）和浆细胞骨髓瘤的治疗方式。虽然真实世界的经验表明该疗法在各个年龄组都取得了成功，但70岁以上的患者由于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）等与治疗相关的并发症而需要特别关注，这些并发症可能导致不良后果。本研究分析了2019年至2023年间接受CAR T细胞疗法治疗的26例年龄≥70岁的r/r BCL患者的治疗结果，比较了接受预防性托珠单抗治疗的患者（N = 7）和接受标准治疗的患者（N = 19）。中位年龄为75岁，患者此前接受的治疗线数中位数为3。在再次输注CAR T细胞前1小时给予预防性托珠单抗。接受预防性托珠单抗治疗的患者出现的与治疗相关的并发症明显较少（p = 0.039），这些并发症被定义为以下一种或多种事件：严重CRS、严重ICANS、使用皮质类固醇、需要输血、在重症监护病房接受治疗、住院时间延长以及转至护理机构。托珠单抗组的总住院天数较短（15.9天对18.5天），但无统计学意义。两组之间的无进展生存期和总生存期相似。结果表明，预防性托珠单抗可能优化老年CAR T细胞患者的管理，这与关于其在r/r BCL中预防性使用的现有证据一致。
