预测免疫效应细胞相关的神经毒性综合征的新型风险因素
medRxiv : the preprint server for health sciences
|January 27, 2025
概括
来自CAR T细胞治疗 (ICANS) 的神经毒性与低基线MOCA得分和注意力缺陷有关. 识别这些因素有助于早期干预和改善CAR-T治疗患者的结果.
科学领域:
- 免疫学 免疫学 免疫学
- 神经学 神经学
- 在瘤学瘤学.
背景情况:
- 免疫效应细胞相关的神经毒性 (ICANS) 是CAR T细胞治疗中的一个重大问题.
- 已确定的危险因素包括高瘤负担,产品类型和细胞剂量,但需要识别新的因素.
研究的目的:
- 在接受CAR T细胞治疗的患者中识别ICANS的新型神经和非神经风险因素.
- 描述ICANS发展和严重程度的预测因素.
主要方法:
- 追溯分析93名接受CD19或BCMA向性CAR T细胞治疗血液恶性瘤的患者.
- 评估基线特征,包括MOCA得分,费里丁,KPS,年龄和先前存在的疾病.
- 这些因素与ICANS发病率和等级的相关性.
主要成果:
- ICANS发生在31.2%的患者中,其中9.7%的患者经历了高等级的ICANS.
- 低基线MOCA得分 (p=0.008),年龄较大 (p=0.024),基线费里丁升高 (p=0.006),低KPS (p=0.004) 和并发的CRS (p<0.001) 与ICANS相关.
- 增加费里和先前暴露于tocilizumab与高等级ICANS有关.
- 接受ICANS治疗的患者90天死亡率更高 (p<0.001).
结论:
- 低基线MOCA分数,特别是注意力受损,是ICANS的独立风险因素.
- 识别这些新型风险因素使积极的患者分层和预防策略成为可能.
- 早期发现和管理ICANS对于改善患者的治疗结果和降低死亡率至关重要.
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