摘要
目的:探讨抗CD19嵌合抗原受体T细胞(CD19-CAR-T细胞)治疗在儿童急性B淋巴细胞白血病(B-ALL)中的临床价值。方法:回顾性分析2018年7月-2022年7月北京京都儿童医院收治的70例复发B-ALL的临床资料。根据治疗方法进行分组,采用阿糖胞苷、泼尼松联合VDLD(长春地辛、地塞米松、培门冬酶、伊达比星)诱导治疗的35例患儿为对照组,采用CD19-CAR-T细胞治疗的35例患儿为观察组。比较两组患儿血清中肿瘤坏死因子-α(TNF-α)与白细胞介素-6(IL-6)水平、近期疗效评估结果、不良反应发生情况。结果:治疗前,两组TNF-α、IL-6水平比较,差异均无统计学意义(P>0.05);治疗后,两组TNF-α、IL-6水平均较治疗前升高,差异均有统计学意义(P<0.05)。治疗后,两组TNF-α、IL-6水平比较,差异均无统计学意义(P>0.05)。观察组完全缓解率高于对照组(P<0.05)。两组患儿有效率比较,差异无统计学意义(P>0.05)。观察组患儿不良反应以细胞因子释放综合征(CRS)相关症状为主,32例发热,1例低血压,1例神经毒性;对照组患儿不良反应以造血功能受抑、感染为主,3例肝脏毒副反应,2例神经毒性。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:CD19-CAR-T细胞治疗复发B-ALL患儿的效果确切,可有效改善病情复发所致TNF-α、IL-6水平降低,不良反应类型以CRS相关症状为主,临床应用需警惕神经毒性与其他严重副作用。
Objective:To investigate the clinical value of anti CD19 chimeric antigen receptor T cells(CD19-CAR-T cells)in children with acute B-lymphoblastic leukemia(B-ALL).Method:The clinical data of 70 patients with recurrent B-ALL admitted to Beijing Jingdu Children's Hospital from July 2018 to July 2022 were retrospectively analyzed.According to the treatment method,35 children treated with Cytarabine were selected as the control group,Metacortandracin combined with VDLD(Vindesine,Dexamethasone,Aspartase,Idabicin)induction therapy,and 35 children treated with CD19-CAR-T cells were selected as the observation group.The serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),the results of short-term efficacy evaluation and the occurrence of adverse reactions were compared between the two groups.Result:Before treatment,there were no significant differences in the levels of TNF-αand IL-6 between the two groups(P>0.05);after treatment,the levels of TNF-αand IL-6 in both groups were higher than those before treatment,the differences were statistically significant(P<0.05).After treatment,there were no significant differences in the levels of TNF-αand IL-6 between the two groups(P>0.05).The complete remission rate in observation group was higher than that in control group(P<0.05).There was no significant difference in the effective rate between the two groups(P>0.05).In the observation group,the adverse reactions were mainly related to cytokine release syndrome(CRS),with fever in 32 cases,hypotension in 1 case and neurotoxicity in 1 case.In the control group,hematopoietic inhibition and infection were the main adverse reactions,3 cases of liver toxicity and 2 cases of neurotoxicity.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:CD19-CAR-T cells are effective in the treatment of children with recurrent B-ALL,and can effectively improve the decreased levels of TNF-αand IL-6 caused by relapse,the adverse reactions are mainly CRS-related symptoms,and the clinical application should be wary of neurotoxicity and other serious side effects.
作者
刘宇凯
刘琦
马聪
王竹青
刘周阳
孙媛
LIU Yukai;LIU Qi;MA Cong;WANG Zhuqing;LIU Zhouyang;SUN Yuan(Beijing Jingdu Children's Hospital,Beijing 102208,China;不详)
出处
《中国医学创新》
CAS
2023年第16期43-47,共5页
Medical Innovation of China
