与多发性髓瘤患者的CAR-T疗法相关的胃肠道损伤模式
Leah Osnis1, John Hart, Andrea Olivas
1Department of Pathology,University of Chicago, Chicago, IL.
The American journal of surgical pathology
|December 10, 2025
概括
化学抗原受体T细胞 (CAR-T) 治疗多发性骨髓瘤 (MM) 导致独特的胃肠变化,主要是在小肠. 发现包括状缩和增加细胞死亡,表明免疫介导损伤.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 针对B细胞成熟抗原 (BCMA) 的CAR-T疗法是治疗多发性骨髓瘤 (MM) 的新疗法.
- 胃肠道 (GI) 的副作用很常见,但特定的组织病理变化没有得到很好的描述.
研究的目的:
- 在接受BCMA向性CAR-T治疗的多发性骨髓瘤患者中研究胃肠道组织病理变化的频谱.
主要方法:
- 对10名MM患者的26个胃肠道活检样本进行了回顾性分析,这些患者接受了BCMA向性CAR-T治疗.
- 组织病理学检查侧重于血细胞计数,淋巴细胞透,状结构和亡.
主要成果:
- 在大多数标本中观察到显著减少或缺失血细胞.
- 小肠,特别是十二指肠,表现出最显著的变化:自身膜淋巴细胞透,小性缩,状转化,以及增加的亡体 (7/10 hpf).
- 末端结核也显示了亡的增加 (9.5/10 hpf),小性缩和淋巴细胞透. 胃活检显示有轻微的炎症;结肠活检不同,有些显示有活性的结肠炎,有些显示微小的变化.
结论:
- 针对BCMA的CAR-T疗法诱导了一种独特的肠道损伤模式,主要影响小肠.
- 组织学发现包括血细胞枯竭,淋巴细胞透,状缩和亡的增加.
- 上部内镜对于患有症状的患者来说至关重要,因为CAR-T治疗后的十二指肠损伤不成比例地大.
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