Commercially available anti-CD19 chimeric antigen receptor T cells (CARΤ cells) have offered long-term survival to a constantly expanding patient population. Given that novel toxicities including cytokine release syndrome (CRS) and neurotoxicity (ICANS) have been observed, we aimed to document the safety and toxicity of this treatment in a real-world study. We enrolled 31 adult patients referred to our center for CAR T therapy. Tisagenlecleucel was infused in 12 patients, axicabtagene ciloleucel in 14, and brexucabtagene autoleucel in 5. Cytokine release syndrome was noted in 26 patients while neurotoxicity was observed in 7. Tocilizumab was administered for CRS in 18 patients, along with short-term, low-dose steroid administration in one patient who developed grade III CRS and, subsequently, grade I ICANS. High-dose steroids, along with anakinra and siltuximab, were administered in only two MCL patients. With a median follow-up time of 13.4 months, nine patients were then in CR. The progression-free (PFS) and overall survival (OS) rates were 41.2% and 88.1% at one year, respectively. MCL diagnosis, which coincides with the administration of brexucabtagene autoleucel, was the only factor to be independently associated with poor OS (p< 0.001); meanwhile, increased LDH independently predicted PFS (p= 0.027).In addition, CRP at day 14 was associated with a poor OS (p= 0.001). Therefore, our real-world experience confirmed that commercial CAR T therapy can be administered with minimal toxicity.
市售抗CD19嵌合抗原受体T细胞（CAR T细胞）为不断扩大的患者群体提供了长期生存机会。鉴于已观察到包括细胞因子释放综合征（CRS）和神经毒性（ICANS）在内的新型毒性反应，本研究旨在通过真实世界研究记录该治疗的安全性与毒性特征。我们纳入了31例转诊至本中心接受CAR T治疗的成年患者，其中12例接受替沙仑基奥仑赛输注，14例接受阿基仑赛输注，5例接受布雷基仑赛输注。26例患者出现细胞因子释放综合征，7例出现神经毒性。18例CRS患者接受托珠单抗治疗，其中1例发生III级CRS后出现I级ICANS的患者同时接受了短期低剂量类固醇治疗。仅2例套细胞淋巴瘤患者接受了高剂量类固醇联合阿那白滞素及司妥昔单抗治疗。中位随访时间13.4个月后，9例患者达到完全缓解。一年无进展生存率和总生存率分别为41.2%和88.1%。套细胞淋巴瘤诊断（与布雷基仑赛输注同步）是唯一与不良总生存期独立相关的因素（p<0.001）；同时，乳酸脱氢酶升高独立预测无进展生存期（p=0.027）。此外，第14天C反应蛋白水平与不良总生存期相关（p=0.001）。因此，我们的真实世界经验证实，商用CAR T治疗可在毒性最小化的前提下安全实施。
肿瘤(癌症)患者之家