Impact of glucocorticoids on short-term and long-term outcomes in patients with relapsed/refractory multiple myeloma treated with CAR-T therapy.
Impact of glucocorticoids on short-term and long-term outcomes in patients with relapsed/refractory multiple myeloma treated with CAR-T therapy.
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糖皮质激素对接受 CAR-T 治疗的复发/难治性多发性骨髓瘤患者的短期和长期结局的影响
DOI：
10.3389/fimmu.2022.943004
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发表时间：
2022
影响因子：
7.3
通讯作者：
Xu, Kailin
中科院分区：
文献类型：
--
作者：
Wang, Xue;Qi, Yuekun;Li, Hujun;Liu, Fengan;Cao, Jiang;Chen, Wei;Wang, Ying;Qi, Kunming;Yan, Zhiling;Zhu, Feng;Li, Zhenyu;Cheng, Hai;Xu, Kailin
糖皮质激素（GC）通常用于治疗细胞因子释放综合征（CRS）和免疫效应细胞相关神经毒性综合征（ICANS）。GC对CAR-T细胞治疗复发性/难治性多发性骨髓瘤（RRMM）疗效的影响尚未完全确定。我们评估了GC对接受CAR-T细胞治疗的RRMM患者临床结局的影响。这项研究涉及2017年6月至2020年12月期间在我们中心接受CAR-T细胞治疗的RRMM患者。将患者分为GC使用组（GC组）和非GC使用组（NGC组）。CRS或ICANS根据美国移植和细胞治疗学会共识分级系统进行分级。根据IMWG统一反应标准评价反应状态。计算缓解持续时间（DOR）、无进展生存期（PFS）和总生存期（OS）。本研究共纳入71例患者。在NGC组（40例患者）中，34例（85%）对CAR-T细胞治疗有反应，包括16例（40%）严格完全反应（sCR），7例（17.5%）完全反应（CR），5例（12.5%）非常好的部分反应（VGPR）和6例（15%）部分反应（PR）。NGC组的总有效率（ORR）和完全缓解率（CRR）分别为85%和57.5%。在GC组（31例患者）中，29例（93.5%）有缓解，包括11例（35.5%）sCR，9例（29%）CR，2例（6.4%）VGPR和7例（22.6%）PR。两组之间的ORR和CRR差异不显著。GC的剂量、持续时间和时间不影响ORR和CRR。在中位随访28.2个月时，GC组的中位PFS为20.4个月（95% CI，7.9 - 32.9），而中位OS为36.6个月（95% CI，25.9 - 47.2）。NGC组的中位PFS和OS分别为13.7个月（95% CI，8.8 - 18.6）和27.5个月（95% CI，14.1 - 41.0）。GC组和NGC组之间的PFS或OS均无显著差异。GC组和NGC组中CR或更好患者的中位DOR差异不显著（p = 0.17）。早期，长期使用和高剂量的GC与PFS或OS的任何影响无关。此外，GC对CAR-T细胞增殖没有影响。GC给药、剂量、时间和持续时间不影响本研究中CAR-T细胞在RRMM中的临床疗效。
Glucocorticoids (GCs) are often used to treat cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). The effects of GCs on the efficacy of CAR-T cell treatment in relapsed/refractory multiple myeloma (RRMM) have not been fully established. We evaluated the impact of GCs on clinical outcomes of RRMM patients treated with CAR-T cells. This study involved RRMM patients treated with CAR-T cells at our center between June 2017 and December 2020. Patients were stratified into GC-used group (GC-group) and non-GC-used group (NGC-group). CRS or ICANS was graded on the basis of the American Society of Transplantation and Cellular Therapy consensus grading system. Response status was evaluated by the IMWG Uniform Response Criteria. The duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were calculated. A total of 71 patients were included in this study. In the NGC group (40 patients), 34 (85%) had responses to CAR-T cell therapy, including 16 (40%) stringent complete response (sCR), seven (17.5%) complete response (CR), five (12.5%) very good partial response (VGPR), and six (15%) partial response (PR). The overall response rate (ORR) and complete response rate (CRR) in the NGC group were 85% and 57.5%. In the GC group (31 patients), 29 (93.5%) had responses, including 11 (35.5%) sCR, nine (29%) CR, two (6.4%) VGPR, and seven (22.6%) PR. Differences in ORR and CRR between the two groups were insignificant. The dose, duration, and timing of GCs did not affect ORR and CRR. At a median follow-up of 28.2 months, the median PFS was 20.4 months (95% CI, 7.9 to 32.9) while the median OS was 36.6 months (95% CI, 25.9 to 47.2) for the GC group. The median PFS and OS for the NGC group were 13.7 months (95% CI, 8.8 to 18.6) and 27.5 months (95% CI, 14.1 to 41.0). There were no significant differences in either PFS or OS between the GC group and the NGC group. Differences in median DOR for the patients with CR or better in the GC group and NGC group were not significant (p = 0.17). Earlier, prolonged use and high dose of GCs were not associated with any effects on either PFS or OS. Additionally, GCs had no effects on CAR-T cell proliferation. Administration of GCs, dose, timing, and duration does not influence the clinical efficacy of CAR-T cells in RRMM in this study.
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影响因子：
20.3
作者：
Gardner, Rebecca A.;Finney, Olivia;Jensen, Michael C.
通讯作者：
Jensen, Michael C.
DOI：
10.1056/nejmoa1707447
发表时间：
2017-12-28
期刊：
The New England journal of medicine
影响因子：
--
作者：
Neelapu SS;Locke FL;Bartlett NL;Lekakis LJ;Miklos DB;Jacobson CA;Braunschweig I;Oluwole OO;Siddiqi T;Lin Y;Timmerman JM;Stiff PJ;Friedberg JW;Flinn IW;Goy A;Hill BT;Smith MR;Deol A;Farooq U;McSweeney P;Munoz J;Avivi I;Castro JE;Westin JR;Chavez JC;Ghobadi A;Komanduri KV;Levy R;Jacobsen ED;Witzig TE;Reagan P;Bot A;Rossi J;Navale L;Jiang Y;Aycock J;Elias M;Chang D;Wiezorek J;Go WY
通讯作者：
Go WY
DOI：
10.1038/nrclinonc.2017.148
发表时间：
2018-01
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
Neelapu SS;Tummala S;Kebriaei P;Wierda W;Gutierrez C;Locke FL;Komanduri KV;Lin Y;Jain N;Daver N;Westin J;Gulbis AM;Loghin ME;de Groot JF;Adkins S;Davis SE;Rezvani K;Hwu P;Shpall EJ
通讯作者：
Shpall EJ
影响因子：
20.3
作者：
Strati P;Ahmed S;Furqan F;Fayad LE;Lee HJ;Iyer SP;Nair R;Nastoupil LJ;Parmar S;Rodriguez MA;Samaniego F;Steiner RE;Wang M;Pinnix CC;Horowitz SB;Feng L;Sun R;Claussen CM;Hawkins MC;Johnson NA;Singh P;Mistry H;Johncy S;Adkins S;Kebriaei P;Shpall EJ;Green MR;Flowers CR;Westin J;Neelapu SS
通讯作者：
Neelapu SS
蛋白L：一种通过流式细胞仪检测嵌合抗原受体（CAR）表达的新试剂。
影响因子：
7.4
作者：
Zheng Z;Chinnasamy N;Morgan RA
通讯作者：
Morgan RA