Despite being the mainstay of management for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), there is limited data regarding the impact of tocilizumab (TCZ) and corticosteroids (CCS) on chimeric antigen receptor (CAR) T-cell efficacy in multiple myeloma (MM). The present study aims to evaluate the prognostic impact of these immunosuppressants in recipients of BCMA- or GPRC5D-directed CAR T cells for relapsed/refractory MM. Our retrospective cohort involved patients treated with commercial or investigational autologous CAR T-cell products at a single institution from March 2017–March 2023. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), complete response rate (CRR), and overall survival (OS). In total, 101 patients (91% treated with anti-BCMA CAR T cells and 9% treated with anti-GPRC5D CAR T cells) were analyzed. Within 30 days post-infusion, 34% received CCS and 49% received TCZ for CRS/ICANS management. At a median follow-up of 27.4 months, no significant difference in PFS was observed between CCS and non-CCS groups (log-rank p = 0.35) or between TCZ and non-TCZ groups (log-rank p = 0.69). ORR, CRR, and OS were also comparable between evaluated groups. In our multivariable model, administering CCS with/without TCZ for CRS/ICANS management did not independently influence PFS (HR, 0.74; 95% CI, 0.36–1.51). These findings suggest that, among patients with relapsed/refractory MM, the timely and appropriate use of CCS or TCZ for mitigating immune-mediated toxicities does not appear to impact the antitumor activity and long-term outcomes of CAR T-cell therapy.
尽管托珠单抗（TCZ）和皮质类固醇（CCS）是管理细胞因子释放综合征（CRS）及免疫效应细胞相关神经毒性综合征（ICANS）的主要手段，但关于二者对多发性骨髓瘤（MM）中嵌合抗原受体（CAR）T细胞疗效影响的数据有限。本研究旨在评估这些免疫抑制剂对接受BCMA或GPRC5D靶向CAR T细胞治疗的复发/难治性MM患者预后的影响。我们的回顾性队列纳入了2017年3月至2023年3月在同一机构接受商业化或研究性自体CAR T细胞产品治疗的患者。主要终点为无进展生存期（PFS）。次要终点包括总体缓解率（ORR）、完全缓解率（CRR）和总生存期（OS）。共分析了101例患者（91%接受抗BCMA CAR T细胞治疗，9%接受抗GPRC5D CAR T细胞治疗）。输注后30天内，34%的患者因CRS/ICANS管理接受了CCS治疗，49%接受了TCZ治疗。在中位随访27.4个月时，CCS组与非CCS组之间的PFS（时序检验p=0.35）或TCZ组与非TCZ组之间的PFS（时序检验p=0.69）均未观察到显著差异。各评估组间的ORR、CRR和OS也具可比性。在我们的多变量模型中，为管理CRS/ICANS而使用CCS（联用或不联用TCZ）并未独立影响PFS（风险比0.74；95%置信区间0.36–1.51）。这些结果表明，在复发/难治性MM患者中，及时恰当地使用CCS或TCZ以减轻免疫介导的毒性似乎不会影响CAR T细胞疗法的抗肿瘤活性和长期结局。
肿瘤(癌症)患者之家