摘要
目的:探讨真实世界大B细胞淋巴瘤(large B-cell lymphoma,LBCL)嵌合抗原受体-T(chimeric antigen receptor-T,CART)细胞治疗失败后的结局。方法:回顾性分析2018年7月至2022年12月于南昌大学第一附属医院接受CD19 CAR-T细胞治疗后出现疾病复发/难治性16例LBCL患者的临床资料,分析其后续治疗和预后。结果:16例患者中男性10例、女性6例,中位年龄53.5(16~72)岁,其预后极差,中位总生存期(median overall survival,m OS)仅为5.7个月(95%CI:5.1~6.3)。积极后续抗肿瘤治疗患者12例(75%),mOS为9.8个月(95%CI:3.3~16.3);姑息治疗4例(25%),mOS仅为2.1个月(95%CI:0~4.8),差异具有统计学意义(P<0.05)。后续抗肿瘤方案包括Pola-BR为4例(33.3%)、BTK抑制剂4例(33.3%)、抗PD-1抗体2例(16.7%)和免疫化疗2例(16.7%),最佳疗效为部分缓解4例(33.3%)。BTK抑制剂组2例(50%)为部分缓解,mOS为10.8个月(95%CI:3.4~18.1),较其他方案似有获益趋势,但差异无统计学意义(P>0.05)。结论:CAR-T治疗后复发或进展的LBCL患者预后差,治疗手段局限,如何合理化分层使用后线治疗策略未来值得探索。
Objective:To analyze real-word experience of patients with relapsed/refractory large B-cell lymphoma(LBCL)after failure of chimeric antigen receptor-T(CAR-T)cell therapy.Methods:We retrospectively evaluated clinical outcomes and salvage therapies from 16 patients who relapsed or progressed following CD19 CAR-T cell therapy at The First Affiliated Hospital of Nanchang University between July 2018 and December 2022.Results:The cohort had 10 males and 6 females,with a median age of 53.5 years(range,16-72).The prognosis of these patients was extremely poor,with a median overall survival(mOS)of only 5.7 months(95%confidence interval[CI]:5.1-6.3).Compared with supportive or palliative care exhibiting a mOS of 2.1 months(n=4,95%CI:0–4.8),subsequent antitumor therapies(n=12)were associated with a statistically significant survival benefit,with a mOS of 9.8 months(95%CI:3.3–16.3,P<0.05).Next-line antitumor regimens included Pola-BR(n=4,33.3%),BTK inhibitor(n=4,33.3%),anti-PD-1 antibody(n=2,16.7%),and conventional immune-chemotherapy(n=2,16.7%),witha partial response observed in four patients(33.3%).For the BTK inhibitor-based treatment,two cases(50%)exhibited a partial response,and the mOS was 10.8 months(95%CI:3.4-18.1),which showed a trend of superiority compared with the other regimens(P>0.05).Conclusions:CAR-T cell therapy failure demonstrated a very poor prognosis and the treatment options were very limited for patients with LBCL.Further research is needed to determine the optimal salvage regimen following failure of CAR-T cell therapy.
作者
喻敏
孔繁聪
周玉兰
齐凌
李菲
Min Yu;Fancong Kong;Yulan Zhou;Ling Qi;Fei Li(Department of Hematology,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2023年第19期983-987,共5页
Chinese Journal of Clinical Oncology
基金
国家自然科学基金地区项目(编号:81960041)
江西省卫健委科技计划项目(编号:202210463)
江西省科技合作专项项目(编号:2021BDH80024)资助。
