在BCMA CAR-T细胞治疗后,CD4+ T细胞调解CAR-T细胞相关的免疫相关不良事件
Matthew Ho1,2,3, Luca Paruzzo1,2,3,4, Julia Han Noll2
1Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Nature medicine
|January 15, 2026
概括
针对B细胞成熟抗原 (BCMA) 向的化学抗原受体 (CAR) T细胞疗法会导致独特的毒性,称为CAR T细胞疗法相关的免疫相关不良事件 (CirAEs). CD4+ CAR T 细胞扩张与这些严重事件有关,增加死亡风险.
科学领域:
- 免疫治疗是一种免疫疗法.
- 在瘤学瘤学.
- 细胞疗法细胞疗法
背景情况:
- 针对B细胞成熟抗原 (BCMA) 向的化学抗原受体 (CAR) T细胞疗法为多发性骨髓瘤提供了一种革命性的治疗方法.
- 这种治疗可以导致独特的毒性,统称为CAR T细胞治疗相关的免疫相关不良事件 (CirAEs),包括神经和胃肠道并发症.
研究的目的:
- 调查接受BCMA向的CAR T细胞治疗的患者中CiraE的发生率,风险因素和潜在机制.
- 确定管理这些不良事件的潜在治疗点.
主要方法:
- 在2021年6月至2024年12月期间,对198名患者进行了回顾性分析,这些患者接受了针对BCMA的特定CAR T细胞疗法 (ciltacabtagene autoleucel或idecabtagene vicleucel).
- 临床数据的分析,包括不良事件的发生,淋巴细胞计数,非比率和组织透.
- 在体外研究评估CCR5抑制在缓解CAR T细胞扩张中的作用.
主要成果:
- 27名患者 (13.6%) 患有CiraE,其中1例患有与极端CD4+CAR T细胞扩张相关的3种不同的CiraE.
- CirAEs与较高的非复发死亡率 (HR=5.2,P=0.006) 有意义地相关.
- 针对CiraEs的独立风险因素包括特定的CAR T细胞产物,输液后的高峰绝对淋巴细胞计数,以及高的CD4:CD8分离率. 在受影响的组织中观察到有标记的CD4+CAR T细胞透.
结论:
- 在BCMA向的CAR T细胞治疗中,CD4+CAR T细胞扩张和透是CiraEs的关键媒介.
- 识别风险因素和了解CD4+T细胞的作用对于管理这些严重的毒性至关重要.
- 抑制CCR5显示出在体外消除极端CAR-T细胞扩张的潜力.
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