Relationship between platelet count and the efficacy of CD19-CAR-T cells in the treatment of refractory/relapsed acute B-lymphoblastic leukemia
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摘要: 目的 研究血小板数值与CD19-CAR-T细胞治疗难治/复发急性B淋巴细胞白血病疗效的关系。方法 回顾性分析2017年5月—2020年5月84例接受CD19-CAR-T细胞治疗难治/复发急性B淋巴细胞白血病患者的临床资料。将患者分为CAR-T细胞治疗后微小残留病(MRD)阴性组(46例)和CAR-T细胞治疗后MRD阳性组(38例)，比较2组患者CAR-T细胞回输当天及回输后第7天、第14天、第21天和第28天的血小板数值。结果 CAR-T细胞治疗后MRD阴性组在CD19-CAR-T细胞回输时和回输后第7天、第14天、第21天的中位血小板数值分别为109.0×109/L、57.0×109/L、83.7×109/L和35.0×109/L，明显高于MRD阳性组的31.5×109/L、24.0×109/L、18.0×109/L和18.0×109/L，2组比较差异有统计学意义(P< 0.05)。结论 血小板数值与CAR-T细胞治疗的疗效呈正相关，且CAR-T细胞回输当天的血小板数值可以预测CAR-T细胞的疗效。
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关键词:
- 急性淋巴细胞白血病 /
- 难治 /
- 复发 /
- 嵌合抗原受体T细胞治疗 /
- 血小板
Abstract: Objective To study the relationship between platelet count and the efficacy of CD19 chimeric antigen receptor T(CD19-CAR-T) cells in the treatment of refractory/relapsed acute B-lymphoblastic leukemia.Methods The clinical data of 84 patients with refractory/relapsed acute B-lymphoblastic leukemia treated with CD19-CAR-T cells from May 2017 to May 2020 were analyzed retrospectively. The patients were divided into the minimal residual disease(MRD) negative group(46 cases) and the MRD positive group(38 cases) after CAR-T therapy. The platelet values on the day of CAR-T cell reinfusion and the 7th, 14th, 21st and 28th days after reinfusion were compared between the two groups.Results The median platelet values of the MRD negative group at the time of CD19-CAR-T cell reinfusion and on the 7th, 14th, and 21st days after reinfusion were 109.0×109/L, 57.0×109/L, 83.7×109/L, and 35.0×109/L, respectively, which were significantly higher than 31.5×109/L, 24.0×109/L, 18.0×109/L, and 18.0×109/L in MRD positive group(P< 0.05).Conclusion The platelet value is positively correlated with the efficacy of CAR-T cell therapy, and the platelet value on the day of CAR-T cell reinfusion can predict the efficacy of CAR-T cell therapy. -
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表 1 2组患者临床特征比较
临床特征 MRD阴性组(46例) MRD阳性组(38例) P 年龄/岁 17(2~53) 21(1~56) 0.289 男∶女/例 28∶18 22∶16 0.826 复杂染色体/% 43.6 48.2 0.292 预处理前骨髓原始细胞数/% 32.1(9.8~91.0) 48.0(18.0~88.0) 0.186 CAR-T细胞回输当天骨髓原始细胞数/% 5(0~96) 52(0~98) 0.017 CAR-T细胞回输当天MRD水平/% 1(0~83) 29(0~84) 0.029 CAR-T细胞峰值/% 22.0(1.0~72.6) 15.0(0~58.8) 0.238 CRS/例(%) 20(43.5) 23(60.5) 0.132 
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表 2 2组患者外周血细胞参数比较
组别 MRD阴性组(46例) MRD阳性组(38例) P 不同时点血小板数值/(×109·L-1) CAR-T细胞回输当天 109.0(17.1~386.3) 31.5(2.3~407.0) 0.006 CAR-T细胞回输第7天 57.0(7.0~250.0) 24.0(4.0~394.0) 0.002 CAR-T细胞回输第14天 83.7(0.3~542.2) 18.0(2.8~303.2) 0.006 CAR-T细胞回输第21天 35.0(8.0~311.0) 18.0(2.0~278.0) 0.047 CAR-T细胞回输第28天 76.2(6.3~295.8) 51.7(3.0~176.6) 0.226 不同时点白细胞数值/(×109·L-1) CAR-T细胞回输当天 1.2(0.1~4.3) 0.7(0~3.0) 0.011 CAR-T细胞回输第7天 3.1(0~64.0) 1.0(0.1~5.0) 0.422 CAR-T细胞回输第14天 1.5(0~7.3) 1.3(0~4.5) 0.736 CAR-T细胞回输第21天 2.0(0~19.4) 3.5(0~31.6) 0.873 CAR-T细胞回输第28天 1.2(0~4.6) 2.2(0~10.0) 0.560 不同时点血红蛋白水平/(g·L-1) CAR-T细胞回输当天 93.3(49.0~134.0) 82.7(41.0~119.0) 0.021 CAR-T细胞回输第7天 84.9(28.0~123.3) 78.3(52.0~105.0) 0.102 CAR-T细胞回输第14天 85.3(0~122.0) 82.5(53.0~130.0) 0.365 CAR-T细胞回输第21天 80.0(9.6~120.0) 81.2(54.9~115.4) 0.972 CAR-T细胞回输第28天 83.6(75.0~133.0) 79.1(59.0~121.0) 0.461 不同时点中性粒细胞数值/(×109·L-1) CAR-T细胞回输当天 1.4(0~19.2) 0.5(0~2.6) 0.004 CAR-T细胞回输第7天 0.4(0~2.9) 0.4(0~3.1) 0.117 CAR-T细胞回输第14天 0.9(0~18.3) 0.6(0~2.3) 0.397 CAR-T细胞回输第21天 0.7(0~3.3) 1.1(0~7.5) 0.378 CAR-T细胞回输第28天 1.3(0~18.8) 0.7(0~5.6) 0.226
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