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系统性炎症和CAR-T特异性毒性作为非复发性死亡率的主要驱动因素:来自意大利前性观察性CART-SIE研究的分析

Angelica Barone¹, Federico Stella², Silva Ljevar³

¹University of Milan, Milano, Italy; Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

Transplantation and cellular therapy

|February 25, 2026

概括

在CAR-T细胞治疗后,非复发性死亡率 (NRM) 是一个令人担忧的问题,感染和毒性是主要原因. 糖尿病和高费里水平等宿主因素独立预测NRM,指导改善患者选择和护理.

科学领域:

血液学血液学血液学
在瘤学瘤学.
免疫治疗是一种免疫疗法.

背景情况:

化学抗原受体 (CAR) -T细胞疗法已经改变了淋巴瘤治疗.
非复发性死亡率 (NRM) 是现实世界CAR-T治疗应用中的一个重大问题.
已知老年和感染是NRM的贡献者.

研究的目的:

在淋巴瘤患者中确定CAR-T细胞治疗后NRM的发生率和原因.
确定与NRM相关的临床和生物风险因素.

主要方法:

对接受CAR-T细胞 (2019-2025) 淋巴瘤患者的前性多中心观察队列 (CART-SIE研究) 的分析.
评估NRM的原因和决定因素使用细分和灰分区危险模型.
对影响NRM的输注前和输注后因素的评估.

主要成果:

一年和两年的NRM累积发病率分别为5.5%和8.8%.
感染 (51%) 和CAR-T急性毒性 (30%) 是NRM的主要原因.
NRM的独立预测因素包括高费里水平和糖尿病 (输注前),以及严重的CRS,ICANS和感染 (输注后).

结论:

与宿主相关的因素和炎症显著影响CAR-T治疗结果.
优化患者选择,毒性管理和感染预防对于缓解NRM至关重要.
长期监测对于最大限度地发挥CAR-T细胞疗法的益处至关重要.

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