急性髓系白血病患者微型移植后的异种供体细胞输注综合征。
Mismatched donor cell infusion-related syndrome following microtransplant in patients with acute myeloid leukemia.
发表日期:2023 Mar 28
作者:
Bo Cai, Xiaoyan Zou, Xin Ning, Tieqiang Liu, Bingxia Li, Yaqing Lei, Jianhui Qiao, Kaixun Hu, Yangyang Lei, Zhiqing Liu, Bo Yao, Huisheng Ai, Yi Wang, Changlin Yu, Mei Guo
来源:
CHINESE MEDICAL JOURNAL
摘要:
免疫治疗,如细胞免疫治疗和免疫调节剂,广泛用于癌症治疗,同时常见的症状包括细胞因子释放综合征(CRS)或免疫相关不良事件(irAEs)。然而,在接受微型移植(MST)的患者中,由不匹配的供体粒细胞集落刺激因子动员外周血单个核细胞(GPBMC)输注引起的临床表现尚未明确。我们分析了88个周期的不匹配GPBMC输注和54个周期的化疗组对比时不进行GPBMC输注,在接受MST的急性髓性白血病患者中,探索临床症状及其与临床特征,实验室检查和临床反应的相关性。GPBMC输注后,发热(58.0%[51/88])和寒战(43.2%[38/88])是重要的早期症状。供体与受体间人类白细胞抗原匹配位点较少或与供体不相关的患者更容易出现寒战(3 [2-5]位点与5 [3-5]位点,P = 0.043和66.7%[12/18]与37.1%[26/70],P = 0.024)。另一方面,CD4 + / CD8 + T细胞比例降低的患者更容易发热(0.8 [0.7-1.2]与1.4 [1.1-2.2],P = 0.007)。多元分析显示,年轻患者发热的可能性更大(比值比[OR] = 0.963,95%置信区间[CI]:0.932-0.995,P = 0.022),而年轻供体的患者更容易出现寒战(OR = 0.915,95%CI:0.859-0.975,P = 0.006)。在没有细胞因子风暴的情况下,GPBMC输注后观察到升高的超敏C反应蛋白水平,表明轻度和短暂的炎症反应。尽管输注相关综合征对白血病负担变化没有预测价值,但宿主治疗前激活的T细胞比例与白血病控制呈正相关。MST中的不匹配GPBMC输注引起了独特的输注相关症状和实验室变化,这些与供体或接收方来源的风险因素相关,与报道的CRS或irAE相比,安全性和耐受性问题较少。版权所有©2023年中国医学协会,由沃尔特斯·克鲁伊公司在CC-BY-NC-ND许可下生产。
Immunotherapies such as adoptive immune cell infusion and immune-modulating agents are widely used for cancer treatment, and the concomitant symptoms, including cytokine release syndrome (CRS) or immune-related adverse events (irAEs), are frequently reported. However, clinical manifestations induced by mismatched donor granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell (GPBMC) infusion in patients receiving microtransplant (MST) have not yet been well depicted.We analyzed 88 cycles of mismatched GPBMC infusion in patients with acute myeloid leukemia receiving MST and 54 cycles of chemotherapy without GPBMC infusion as a comparison. Clinical symptoms and their correlation with clinical features, laboratory findings, and clinical response were explored.Fever (58.0% [51/88]) and chills (43.2% [38/88]) were the significant early-onset symptoms after GPBMC infusion. Patients possessing less human leukocyte antigen-matching loci with the donor or those with unrelated donors experienced more chills (3 [2-5] loci vs. 5 [3-5] loci, P = 0.043 and 66.7% [12/18] vs. 37.1% [26/70], P = 0.024). On the other hand, those with decreased CD4+/CD8+ T-cell ratio developed more fever (0.8 [0.7-1.2] vs. 1.4 [1.1-2.2], P = 0.007). Multivariable analysis demonstrated that younger patients experienced more fever (odds ratio [OR] = 0.963, 95% confidence interval [CI]: 0.932-0.995, P = 0.022), while patients with younger donors experienced more chills (OR = 0.915, 95% CI: 0.859-0.975, P = 0.006). Elevated ultra-sensitive C-reactive protein levels in the absence of cytokine storm were observed following GPBMC infusion, which indicated mild and transient inflammatory response. Although no predictive value of infusion-related syndrome to leukemia burden change was found, the proportion of host pre-treatment activated T cells was positively correlated with leukemia control.Mismatched GPBMC infusion in MST induced unique infusion-related symptoms and laboratory changes, which were associated with donor- or recipient-derived risk factors, with less safety and tolerance concerns than reported CRS or irAEs.Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.