【摘要】 目的观察酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs)对CD19嵌合抗原受体修饰(CAR)T细胞在难治/复发Ph~+急性淋巴细胞白血病(ALL)中的扩增、疗效及不良反应的影响。方法收集10例难治/复发Ph~+ ALL患者(TKIs组)和16例难治/复发Ph阴性B-ALL患者(非TKIs组),TKIs组给予TKIs口服。在输注CD19 CAR-T细胞后第0、4、7、14、21和28天分别检测外周血中CD19 CAR-T细胞,分析两组输注后的疗效及不良反应。结果 TKIs组外周血中CD19 CAR-T细胞的峰值高于非TKIs组,两组差异有统计学意义(P=0.0037);两组细胞因子峰值、细胞因子释放综合征(CRS)分级、第14天完全缓解(CR)率、总生存率(OS)和无病生存率(DFS)差异均无统计学意义(P>0.05)。结论 TKIs促进CD19 CAR-T细胞在难治/复发Ph~+ ALL中的扩增,不抑制CD19 CAR-T细胞的疗效,不加重其不良反应,近期及远期疗效肯定。更多还原

【Abstract】 Objective To observe the influence of tyrosine kinase inhibitors(TKIs) on the proliferation, efficacy and adverse reactions(AEs) of CD19 CAR-T cells in refractory/relapsed Ph~+ acute lymphoblastic leukemia(Ph~+ ALL).Methods Ten patients with refractory/relapsed Ph~+ ALL(TKIs group) and 16 patients with refractory/relapsed Ph-negative B-ALL(non-TKIs group) were collected, and TKIs group was given TKIs orally. CD19 CAR-T cells were detected in peripheral blood at 0, 4, 7, 14, 21 and 28 days after infusion, and the clinical efficacy and AEs of two groups were analyzed. Results The peak value of CD19 CAR-T cells in peripheral blood in TKIs group was higher than that in non-TKIs group, with statistically significant differences between the two groups(P=0.0037). There were no statistically significant differences in cytokine peak, cytokine release syndrome(CRS) grading, the complete response(CR) rate at day 14, overall survival(OS) rate and disease-free survival(DFS) rate between the two groups(P>0.05). Conclusion TKIs promoted the proliferation of CD19 CAR-T cells in refractory/relapsed Ph~+ ALL, without inhibiting the clinical efficacy of CD19 CAR-T cells and aggravating AEs, which showed positively short-term and long-term effects.更多还原