[Fever Characteristics and Biomarker Changes of CRS in Patients with Relapsed/Refractory Multiple Myeloma after CAR-T Cell Therapy].

Q4 Medicine 中国实验血液学杂志 Pub Date : 2024-12-01 DOI:10.19746/j.cnki.issn.1009-2137.2024.06.017

Tian Hua, Jiao-Jiao Wang, Sheng-Wei Ji, Jia-Ying Liu, Zi-Han Chen, Ling-Yan Shao, Hai Cheng, Jiang Cao

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Abstract

Objective: To investigate the correlation of the clinical characteristics, fever characteristics, serum biomarkers with cytokine release syndrome (CRS) in patients with relapsed/refractory multiple myeloma (R/R MM) treated with chimeric antigen receptor T cell (CAR-T) immunotherapy.

Methods: 104 R/R MM patients who received CAR-T cell therapy at the Affiliated Hospital of Xuzhou Medical University from June 2017 to November 2021 were included, and the correlations of their clinical characteristics, fever characteristics, serum biomarkers with the severity of CRS were analyzed.

Results: Among 104 R/R MM patients receiving CAR-T treatment, no CRS was observed in 8 cases (7.7%), and 96 cases (92.3%) developed CRS. Patients with high-risk cytogenetics had a higher risk of developing CRS (P =0.040), while patients who had previously received autologous hematopoietic stem cell transplantation (ASCT) had a lower risk of developing CRS (P =0.004). There was a significant difference in the duration of fever between patients with grade 1-2 and grade 3-5 CRS (P =0.006). The highest body temperature varied among patients with different treatment regimens (P =0.001). The decrease in total protein in patients with CRS was more significant than in patients without CRS (P =0.002). Within one month after CAR-T cell infusion, the degree of albumin recovery in patients with grade 3-5 CRS was lower than that in patients with grade 0-2 CRS (P =0.037). Compared to patients with grade 1-2 CRS, patients with grade 3-5 CRS showed a significant increase in heart rate after CAR-T cell infusion (P =0.013), while IL-6, C-reactive protein (CRP), and serum ferritin (SF) also showed significant increases (P =0.007, P < 0.001, P =0.003).

Conclusion: High-risk cytogenetics is a risk factor for severe CRS. Long duration of fever is a clinical characteristic of severe CRS. CRP can better reflect the severity of CRS.

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CAR-T细胞治疗后复发/难治性多发性骨髓瘤患者CRS的发热特征及生物标志物变化。

目的：探讨嵌合抗原受体T细胞（CAR-T）免疫疗法治疗复发/难治性多发性骨髓瘤（R/R MM）患者的临床特征、发热特征、血清生物标志物与细胞因子释放综合征（CRS）的相关性。方法：纳入2017年6月至2021年11月在徐州医科大学附属医院接受CAR-T细胞治疗的104例R/R MM患者，分析其临床特征、发热特征、血清生物标志物与CRS严重程度的相关性。结果：104例接受CAR-T治疗的R/R MM患者中，8例（7.7%）未发生CRS， 96例（92.3%）发生CRS。高危细胞遗传学患者发生CRS的风险较高（P =0.040），而先前接受过自体造血干细胞移植（ASCT）的患者发生CRS的风险较低（P =0.004）。1-2级和3-5级CRS患者发热持续时间差异有统计学意义（P =0.006）。不同治疗方案患者的最高体温存在差异（P =0.001）。CRS患者总蛋白的下降比无CRS患者更显著（P =0.002）。CAR-T细胞输注后1个月内，3-5级CRS患者白蛋白恢复程度低于0-2级CRS患者（P =0.037）。与1-2级CRS患者相比，3-5级CRS患者CAR-T细胞输注后心率显著升高（P =0.013）， IL-6、c反应蛋白（CRP）、血清铁蛋白（SF）也显著升高（P =0.007, P < 0.001, P =0.003）。结论：高危细胞遗传学是严重CRS的危险因素。发热持续时间长是重症CRS的临床特征。CRP能较好地反映CRS的严重程度。

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