大 B 细胞淋巴瘤抗 CD19 CAR T 细胞治疗后严重 CRS 和 ICANS 的新型预后评分系统。

IF 29.5 1区 医学 Q1 HEMATOLOGY
Pierre Sesques, Amy A Kirkwood, Mi Kwon, Kai Rejeski, Michael D Jain, Roberta Di Blasi, Gabriel Brisou, François-Xavier Gros, Fabien le Bras, Pierre Bories, Sylvain Choquet, Marie-Thérèse Rubio, Gloria Iacoboni, Maeve O'Reilly, René-Olivier Casasnovas, Jacques-Olivier Bay, Mohamad Mohty, Magalie Joris, Julie Abraham, Cristina Castilla Llorente, Mickael Loschi, Sylvain Carras, Adrien Chauchet, Laurianne Drieu La Rochelle, Olivier Hermine, Stéphanie Guidez, Pascale Cony-Makhoul, Patrick Fogarty, Steven Le Gouill, Franck Morschhauser, Thomas Gastinne, Guillaume Cartron, Marion Subklewe, Frederick L Locke, Robin Sanderson, Pere Barba, Roch Houot, Emmanuel Bachy
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引用次数: 0

摘要

自体抗CD19嵌合抗原受体(CAR)T细胞现已用于治疗复发/难治性(R/R)大B细胞淋巴瘤(LBCL)。严重(≥3级)的细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性(ICANS)仍然是最令人担忧的急性毒性,它们会导致患者频繁入住重症监护室(ICU)、延长住院时间并增加大量治疗费用。我们根据DESCAR-T登记处收集的患者数据,报告了法国925名接受阿昔卡巴替尼西洛昔洛韦(axi-cel)或替沙格列昔洛韦(tisa-cel)治疗的LBCL患者的CRS和ICANS发生率及治疗结果。778名患者(84.1%)发生了任何级别的CRS,其中74名患者(8.0%)发生了3级或更高级别CRS,375名患者(40.5%)发生了任何级别的ICANS,其中112名患者(12.1%)发生了≥3级的ICANS。根据多变量分析选择的参数,得出了两个独立的预后评分系统(PSS),一个针对≥3级的CRS,另一个针对≥3级的ICANS。CRS-PSS 包括大块病变、血小板计数 30 mg/L、无桥接治疗或桥接治疗后病情稳定或进展(SD/PD)。CRS-PSS评分大于2的患者发生≥3级CRS的风险明显更高。ICANS-PSS包括女性性别、血小板水平低(2分)的患者发生≥3级ICANS的风险明显更高。这两项评分均在接受 tisa-cel 或 axi-cel 治疗的国际患者队列中进行了外部验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel prognostic scoring systems for severe CRS and ICANS after anti-CD19 CAR T cells in large B-cell lymphoma.

Autologous anti-CD19 chimeric antigen receptor (CAR) T cells are now used in routine practice for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Severe (grade ≥ 3) cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are still the most concerning acute toxicities leading to frequent intensive care unit (ICU) admission, prolonging hospitalization, and adding significant cost to treatment. We report on the incidence of CRS and ICANS and the outcomes in a large cohort of 925 patients with LBCL treated with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) in France based on patient data captured through the DESCAR-T registry. CRS of any grade occurred in 778 patients (84.1%), with 74 patients (8.0%) with grade 3 CRS or higher, while ICANS of any grade occurred in 375 patients (40.5%), with 112 patients (12.1%) with grade ≥ 3 ICANS. Based on the parameters selected by multivariable analyses, two independent prognostic scoring systems (PSS) were derived, one for grade ≥ 3 CRS and one for grade ≥ 3 ICANS. CRS-PSS included bulky disease, a platelet count < 150 G/L, a C-reactive protein (CRP) level > 30 mg/L and no bridging therapy or stable or progressive disease (SD/PD) after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 CRS. ICANS-PSS included female sex, low level of platelets (< 150 G/L), use of axi-cel and no bridging therapy or SD/PD after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 ICANS. Both scores were externally validated in international cohorts of patients treated with tisa-cel or axi-cel.

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来源期刊
CiteScore
48.10
自引率
2.10%
发文量
169
审稿时长
6-12 weeks
期刊介绍: The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.
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