Remission after CAR T-cell therapy: Do lymphoma patients recover a normal life?

IF 7.6 2区医学 Q1 HEMATOLOGY

HemaSphere Pub Date : 2024-05-27 DOI:10.1002/hem3.72

Alya Perthus, Fanny Colin, Emilie Charton, Amélie Anota, Faustine Lhomme, Guillaume Manson, Sophie De Guibert, Pierre Daufresne, Adeline Bellec, Laetitia Le Bars, Sandra De Barros, Loïc Ysebaert, Marianne Merceur, Mélanie Cogné, Thierry Lamy De La Chapelle, Roch Houot, Aline Moignet

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Abstract

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.

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CAR T 细胞疗法后的缓解：淋巴瘤患者能否恢复正常生活？

嵌合抗原受体 T 细胞（CAR T 细胞）可诱导相当一部分复发/难治性淋巴瘤患者延长缓解期。然而，人们对 CAR T 细胞治疗后患者的生活知之甚少。我们对处于缓解期的淋巴瘤患者在白细胞清除术前、CAR T 细胞输注前及其后 3、6 和 12 个月的多维康复情况进行了前瞻性评估。采用经过验证的工具来测量淋巴瘤相关和整体健康相关生活质量（HRQoL；癌症治疗功能评估-淋巴瘤[FACT-Lym]和EQ-5D-5L）、认知症状（FACT-认知）、疲劳（FACIT-疲劳分量表）、心理状态（医院焦虑和抑郁量表、创伤后核对表量表）以及性能力（人际关系和性能力量表）。在缓解期满 12 个月后，我们还对身体、职业、性和一般生活状况进行了调查。在 3 个月、6 个月和 12 个月时，分别有 53 名、35 名和 23 名患者接受了评估。在 3、6 和 12 个月时，淋巴瘤相关 HRQoL 的改善与临床相关，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）。总体 HRQoL、疲劳和焦虑的改善与临床相关，但随着时间的推移，20%-40% 的患者会出现持续疲劳、心理困扰和认知抱怨。CAR T 细胞治疗 12 个月后，22 名可评估患者中有 81.8% 对自己的日常生活感到满意。近一半的患者在体育活动、职业、性生活和整体健康方面恢复到了诊断前的水平。我们发现，CAR T 细胞治疗后，患者的 HRQoL 有所改善，包括焦虑、抑郁、性满意度和总体幸福感。然而，并非所有患者都能恢复 "正常生活"。需要进一步研究确定哪些患者有生活质量受损的风险，以改善CAR T细胞输注后的恢复情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HemaSphere Medicine-Hematology

CiteScore

6.10

自引率

4.50%

发文量

2776

审稿时长

7 weeks

期刊介绍： HemaSphere, as a publication, is dedicated to disseminating the outcomes of profoundly pertinent basic, translational, and clinical research endeavors within the field of hematology. The journal actively seeks robust studies that unveil novel discoveries with significant ramifications for hematology. In addition to original research, HemaSphere features review articles and guideline articles that furnish lucid synopses and discussions of emerging developments, along with recommendations for patient care. Positioned as the foremost resource in hematology, HemaSphere augments its offerings with specialized sections like HemaTopics and HemaPolicy. These segments engender insightful dialogues covering a spectrum of hematology-related topics, including digestible summaries of pivotal articles, updates on new therapies, deliberations on European policy matters, and other noteworthy news items within the field. Steering the course of HemaSphere are Editor in Chief Jan Cools and Deputy Editor in Chief Claire Harrison, alongside the guidance of an esteemed Editorial Board comprising international luminaries in both research and clinical realms, each representing diverse areas of hematologic expertise.