Objective: This study aimed to evaluate the effect of early tocilizumab intervention to relieve cytokine release syndrome (CRS) following chimeric antigen receptor T cell (CAR-T) therapy. Methods: Twenty-two patients with acute lymphoblastic leukemia who received tocilizumab to relieve CRS response after CAR-T cell infusion in our research center from October 2015 to July 2021 were retrospectively analyzed. According to the timing of tocilizumab intervention, patients were divided into the conventional and early intervention groups. Patients who received tocilizumab treatment after sustained high fever for 4 h were included in the early intervention group. The clinical data, CRS grade, and event-free survival (EFS) between the two groups were evaluated. Results: Compared with patients who used tocilizumab after severe CRS, no patients in the early intervention group died from CRS, and there was no increased risk of neurotoxicity. Eleven patients (84.62%) achieved complete remission with minimal residual lesions. The median EFS of patients in the early intervention and conventional groups was 2 (95% CI 0-5) and 7 (95% CI 3-11) months, respectively. Conclusion: Early tocilizumab intervention in patients with CRS reduces severe CRS and provides a more optimized therapeutic strategy for CRS caused by CAR-T cell therapy.
目的： 分析早期使用托珠单抗缓解细胞因子释放综合征（CRS）对嵌合抗原受体T细胞（CAR-T细胞）治疗效果的影响。 方法： 收集2015年10月至2021年7月同济大学附属同济医院血液科输注靶向CD19 CAR-T细胞后发生CRS并接受托珠单抗治疗的22例急性淋巴细胞白血病（ALL）患者资料。按照托珠单抗干预的时机分为常规组和早期干预组，患者持续高热4 h即接受托珠单抗治疗的为早期干预组。回顾性分析两组之间的临床资料、CRS分级和无事件生存。 结果： 与发生了严重CRS后常规使用托珠单抗相比，早期干预组没有患者因CRS死亡，没有增加神经毒性风险。11例（84.62%）患者获得微小残留病阴性的完全缓解。常规组和早期干预组的中位无事件生存时间分别为2（95%CI 0~5）个月、7（95%CI 3~11）个月。 结论： 早期使用托珠单抗干预患者的CRS有助于减少重症CRS的发生，并为CAR-T细胞治疗ALL产生的CRS反应提供了更优化的治疗策略。.
Keywords: Chimeric antigen receptor T cell; Cytokine release syndrome; Tocilizumab.