Observation of liver indexes in patients with relapsed/refractory multiple myeloma treated with CAR-T-cells based on BCMA.
10.3760/cma.j.issn.0253-2727.2023.10.007
- VernacularTitle:以B细胞成熟抗原为基础的CAR-T细胞治疗对复发/难治性多发性骨髓瘤患者肝功能影响的临床观察
- Author:
Qian SUN
1
;
Yue Kun QI
1
;
Kun Ming QI
1
;
Zhi Ling YAN
1
;
Hai CHENG
1
;
Wei CHEN
1
;
Feng ZHU
1
;
Wei SANG
1
;
De Peng LI
1
;
Jiang CAO
1
;
Ming SHI
1
;
Zhen Yu LI
1
;
Kai Lin XU
1
Author Information
1. Hematology Institute of Xuzhou Medical University, Hematology Department of The Affiliated Hospital of Xuzhou Medical University, Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cells, Xuzhou 221002, China.
- Publication Type:Journal Article
- Keywords:
Chimeric antigen receptor T-cell;
Liver function;
Multiple myeloma
- MeSH:
Humans;
Antigens, CD19;
B-Cell Maturation Antigen/therapeutic use*;
Bilirubin;
Immunotherapy, Adoptive;
Liver;
Multiple Myeloma/drug therapy*;
Retrospective Studies;
T-Lymphocytes
- From:
Chinese Journal of Hematology
2023;44(10):832-837
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To observe the characteristics of the evolution of liver indexes in patients with relapsed/refractory multiple myeloma (RRMM) treated with CAR-T-cells based on BCMA. Methods: Retrospective analysis was performed of patients with RRMM who received an infusion of anti-BCMA CAR-T-cells and anti-BCMA combined with anti-CD19 CAR-T-cells at our center between June 1, 2019, and February 28, 2023. Clinical data were collected to observe the characteristics of changes in liver indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL) in patients, and its relationship with cytokine-release syndrome (CRS) . Results: Ninety-two patients were included in the analysis, including 41 patients (44.6%) in the group receiving a single infusion of anti-BCMA CAR-T-cells, and 51 patients (55.4%) in the group receiving an infusion of anti-BCMA combined with anti-CD19 CAR-T-cells. After infusing CAR-T-cells, 31 patients (33.7%) experienced changes in liver indexes at or above grade 2, which included 20 patients (21.7%) with changes in one index, five patients (5.4%) with changes in two indexes, and six patients (6.5%) with changes in three or more indexes. The median time of peak values of ALT and AST were d17 and d14, respectively, and the median duration of exceeding grade 2 was 5.0 and 3.5 days, respectively. The median time of peak values of TBIL and DBIL was on d19 and d21, respectively, and the median duration of exceeding grade 2 was 4.0 days, respectively. The median time of onset of CRS was d8, and the peak time of fever was d9. The ALT, AST, and TBIL of patients with CRS were higher than those of patients without CRS (P=0.011, 0.002, and 0.015, respectively). CRS is an independent factor that affects ALT and TBIL levels (OR=19.668, 95% CI 18.959-20.173, P=0.001). The evolution of liver indexes can be reversed through anti-CRS and liver-protection treatments, and no patient died of liver injury. Conclusions: In BCMA-based CAR-T-cell therapy for RRMM, CRS is an important factor causing the evolution of liver indexes. The evolution of liver indexes after CAR-T-cell infusion is transient and reversible after treatment.
