CART细胞治疗患者住院期间心血管不良事件发生的危险因素分析

茆诗源, 马瑞聪, 聂山林, 等. CART细胞治疗患者住院期间心血管不良事件发生的危险因素分析[J]. 临床心血管病杂志, 2021, 37(12): 1106-1111. doi: 10.13201/j.issn.1001-1439.2021.12.008
引用本文: 茆诗源, 马瑞聪, 聂山林, 等. CART细胞治疗患者住院期间心血管不良事件发生的危险因素分析[J]. 临床心血管病杂志, 2021, 37(12): 1106-1111. doi: 10.13201/j.issn.1001-1439.2021.12.008
MAO Shiyuan, MA Ruicong, NIE Shanlin, et al. Risk factors of major adverse cardiovascular events in patients treated with CART cell during hospitalization[J]. J Clin Cardiol, 2021, 37(12): 1106-1111. doi: 10.13201/j.issn.1001-1439.2021.12.008
Citation: MAO Shiyuan, MA Ruicong, NIE Shanlin, et al. Risk factors of major adverse cardiovascular events in patients treated with CART cell during hospitalization[J]. J Clin Cardiol, 2021, 37(12): 1106-1111. doi: 10.13201/j.issn.1001-1439.2021.12.008

CART细胞治疗患者住院期间心血管不良事件发生的危险因素分析

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    通讯作者: 王志荣,E-mail:xzzrw@163.com
  • 中图分类号: R541.9

Risk factors of major adverse cardiovascular events in patients treated with CART cell during hospitalization

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  • 目的:探讨CART细胞治疗患者住院期间发生主要不良心血管事件(MACE)的危险因素。方法:回顾性分析2018年9月—2021年4月于徐州医科大学附属医院接受CART细胞治疗的住院患者155例,其中男90例,女65例。根据MACE发生情况分为事件组34例和非事件组121例。分析两组患者基线资料。使用Cox比例风险回归分析患者发生MACE的影响因素。结果:非MACE组和MACE组在基线治疗使用β受体阻滞剂、血红蛋白(HB)、血小板(PLT)、C反应蛋白(CRP)及白细胞介素(IL-6)水平方面均差异具有统计学意义(均P<0.05),两组在CART细胞治疗后使用类固醇激素、低血压、使用托珠单抗和细胞因子释放综合征(CRS)≥2级方面均差异有统计学意义(均P<0.05)。单因素分析发现基线治疗使用β受体阻滞剂、CART细胞治疗后发生低血压、使用托珠单抗、使用类固醇、CRS≥2级,以及CRP、IL-6、HB、PLT均是MACE发生的影响因素(均P<0.05)。多因素Cox比例风险回归分析CART细胞治疗后发生低血压(HR:3.302,95%CI:1.153~7.971,P<0.05)、CART细胞治疗后CRS≥2级(HR:2.979,95%CI:1.244~7.135,P<0.05)是MACE发生的独立危险因素。χ2检验分析发现,CART细胞治疗后CRS≤1级与CRS≥2级组间MACE发生差异具有统计学意义(13.00%∶64.00%,P<0.05)。Kaplan-Meier生存分析法发现CRS≥2级的患者MACE发生率高于CRS≤1级的患者(P<0.05)。结论:CART细胞治疗后低血压以及CRS≥2级可增加MACE患病风险,在一定程度上可作为CART细胞治疗后患者MACE发生的预测因素。
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  • [1]

    花京剩,张剑,陈苏宁,等.CAR-T细胞技术在复发或难治急性淋巴细胞白血病中的临床应用进展[J].临床血液学杂志,2020,33(1):78-82.

    [2]

    梁爱斌,李萍.CAR-T细胞治疗淋巴瘤的研究进展[J].临床血液学杂志,2020,33(9):599-603.

    [3]

    王祥民,徐开林.多靶点CAR-T细胞治疗在复发难治性多发性骨髓瘤中的应用[J].临床血液学杂志,2020,33(7):446-450.

    [4]

    Ganatra S,Carver JR,Hayek SS,et al.Chimeric antigen receptor T-cell therapy for cancer and heart:JACC council perspectives[J].J Am Coll Cardiol,2019,74(25):3153-3163.

    [5]

    Schubert ML,Schmitt M,Wang L,et al.Side-effect management of chimeric antigen receptor(CAR)T-cell therapy[J].Ann Oncol,2021,32(1):34-48.

    [6]

    Hicks KA,Tcheng JE,Bozkurt B,et al.2014 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials:A report of the American College of Cardiology/American Heart Association task force on clinical data standards(writing committee to develop cardiovascular endpoints data standards)[J].JAm Coll Cardiol,2015,66(4):403-469.

    [7]

    Lefebvre B,Kang Y,Smith AM,et al.Cardiovascular effects of CAR T Cell therapy:A retrospective study[J].JACC CardioOncol,2020,2(2):193-203.

    [8]

    US Department of Health and Human Services.Common Terminology Criteria for Adverse Events (CT-CAE)version 4.03[National Institutes of Health Wed Site][S/OL].[2010-06-14].http://evs.nci.gov/ftpl/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5X7.PDF

    [9]

    Frey N,Porter D.Cytokine release syndrome with chimeric antigen receptor T cell therapy[j].biology of blood and marrow transplantation[J].Biol Blood Marrow Transpl,2019,25(4):e123-e127.

    [10]

    Gill S,June CH.Going viral:chimeric antigen receptor T-cell therapy for hematological malignancies[J].Immunol Rev,2015,263(1):68-89.

    [11]

    Jacoby E,Shahani SA,Shah NN.Updates on CAR T-cell therapy in B-cell malignancies[J].Immunol Rev,2019,290(1):39-59.

    [12]

    Park JH,Geyer MB,Brentjens RJ.CD19-targeted CAR T-cell therapeutics for hematologic malignancies:interpreting clinical outcomes to date[J].Blood,2016,127(26):3312-3320.

    [13]

    Maude SL,Frey N,Shaw PA,et al.Chimeric antigen receptor T cells for sustained remissions in leukemia[J].N Engl J Med,2014,371(16):1507-1517.

    [14]

    Schuster SJ,Svoboda J,Chong EA,et al.Chimeric antigen receptor T cells in refractory B-cell lymphomas[J].N Engl J Med,2017,377(26):2545-2554.

    [15]

    Ali MT,Yucel E,Bouras S,et al.Myocardial strain is associated with adverse clinical cardiac events in patients treated with anthracyclines[J].J Am Soc Echocardiogr,2016,29(6):522-527.e3

    [16]

    Burstein DS,Maude S,Grupp S,et al.Cardiac profile of chimeric antigen receptor T cell therapy in children:A single-institution experience[J].Biol Blood Marrow Transplant,2018,24(8):1590-1595.

    [17]

    Fitzgerald JC,Weiss SL,Maude SL,et al.Cytokine release syndrome after chimeric antigen receptor T cell therapy for acute lymphoblastic leukemia[J].Crit Care Med,2017,45(2):e124-e131.

    [18]

    Cordeiro A,Bezerra ED,Hirayama AV,et al.Late events after treatment with CD19-targeted chimeric antigen receptor modified T cells[J].Biol Blood Marrow Transplant,2020,26(1):26-33.

    [19]

    Alvi RM,Frigault MJ,Fradley MG,et al.Cardiovascular events among adults treated with chimeric antigen receptor T-cells(CAR-T)[J].J Am Coll Cardiol,2019,74(25):3099-3108.

    [20]

    Lee DW,Gardner R,Porter DL,et al.Current concepts in the diagnosis and management of cytokine release syndrome[J].Blood,2014,124(2):188-195.

    [21]

    Porter D,Frey N,Wood PA,et al.Correction to:Grading of cytokine release syndrome associated with the CAR T cell therapy tisagenlecleucel[J].J Hematol Oncol,2018,11(1):81.

    [22]

    Stein-Merlob AF,Rothberg MV,Holman P,et al.Immunotherapy-associated cardiotoxicity of immune checkpoint inhibitors and chimeric antigen receptor Tcell therapy:diagnostic and management challenges and strategies[J].Curr Cardiol Rep,2021,23(3):11.

    [23]

    Oved JH,Barrett DM,Teachey DT.Cellular therapy:Immune-related complications[J].Immunol Rev,2019,290(1):114-126.

    [24]

    Burns EA,Gentille C,Trachtenberg B,et al.Cardiotoxicity associated with anti-CD19 chimeric antigen receptor T-cell(CAR-T)therapy:recognition,risk factors,and management[J].Diseases,2021,9(1).

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出版历程
收稿日期:  2021-06-24
修回日期:  2021-08-26

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