Blood:皮质醇用的越多,采用CAR T细胞疗法治疗的大B细胞淋巴瘤患者的预后越差!

2021-02-04 MedSci原创 MedSci原创

皮质类固醇的剂量、用药时间及持续时间是否会影响其临床疗效?

常采用皮质类固醇管理与嵌合抗原受体(CAR)T细胞疗法相关的重度毒性。然而,目前尚不明确皮质类固醇的剂量、用药时间及持续时间是否会影响其临床疗效。

本研究旨在明确皮质类固醇对采用标准抗CD19 CAR T细胞疗法治疗的复发性/难治性大B细胞淋巴瘤患者的临床预后的影响。

共评估了100位患者,其中60位(60%)接受了皮质类固醇控制CAR T细胞疗法相关毒性。地塞米松当量的中位累积剂量为186 mg(范围 8-1803 mg),皮质类固醇治疗的中位持续时间为9天(范围1-30天)。45位(75%)患者在前7天就开始使用皮质类固醇,有15位(25%)患者使用皮质类固醇超过了7天。

中位随访10个月(95% CI 8-12个月)后,皮质类固醇累积剂量使用的越多,无进展生存期明显越短。更重要的是,较高的皮质类固醇累积剂量,以及在输注CAR T细胞后早早使用皮质类固醇和延长皮质类固醇使用时间,都与总体生存期明显缩短有关。

综上所述,该研究结果表明,在管理CAR T细胞疗法相关毒性时,可以的情况下,皮质类固醇的使用,剂量应尽量小,应用时间应尽可能短,启用时间应尽可能晚。

原始出处:

Paolo Strati, et al. Prognostic Impact of Corticosteroids on Efficacy of Chimeric Antigen Receptor T-cell Therapy in Large B-cell Lymphoma. Blood. https://doi.org/10.1182/blood.2020008865

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (6)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=965885, encodeId=b6fa96588516, content=博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/WrLtFUfyajK3R9Ix3ydJebbk1fUAHMlpSHneByyAx9ticmmbgGY36iaibPzg3p88N5zkF9DfXSlVsrUA8buV3etuA/132, createdBy=58855306914, createdName=陈SY, createdTime=Sat May 15 19:02:05 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702665, encodeId=a93f1e0266577, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Apr 23 03:51:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273383, encodeId=d15b12e33835c, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277824, encodeId=e7f412e78240d, content=<a href='/topic/show?id=e9f2e2180ef' target=_blank style='color:#2F92EE;'>#皮质醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72180, encryptionId=e9f2e2180ef, topicName=皮质醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478054, encodeId=e25614e805490, content=<a href='/topic/show?id=bb6f18030a4' target=_blank style='color:#2F92EE;'>#T细胞疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18030, encryptionId=bb6f18030a4, topicName=T细胞疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6bea7392214, createdName=124984edm24暂无昵称, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=)]
    2021-05-15 陈SY

    博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?

    1

    展开1条回复
  2. [GetPortalCommentsPageByObjectIdResponse(id=965885, encodeId=b6fa96588516, content=博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/WrLtFUfyajK3R9Ix3ydJebbk1fUAHMlpSHneByyAx9ticmmbgGY36iaibPzg3p88N5zkF9DfXSlVsrUA8buV3etuA/132, createdBy=58855306914, createdName=陈SY, createdTime=Sat May 15 19:02:05 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702665, encodeId=a93f1e0266577, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Apr 23 03:51:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273383, encodeId=d15b12e33835c, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277824, encodeId=e7f412e78240d, content=<a href='/topic/show?id=e9f2e2180ef' target=_blank style='color:#2F92EE;'>#皮质醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72180, encryptionId=e9f2e2180ef, topicName=皮质醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478054, encodeId=e25614e805490, content=<a href='/topic/show?id=bb6f18030a4' target=_blank style='color:#2F92EE;'>#T细胞疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18030, encryptionId=bb6f18030a4, topicName=T细胞疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6bea7392214, createdName=124984edm24暂无昵称, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=965885, encodeId=b6fa96588516, content=博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/WrLtFUfyajK3R9Ix3ydJebbk1fUAHMlpSHneByyAx9ticmmbgGY36iaibPzg3p88N5zkF9DfXSlVsrUA8buV3etuA/132, createdBy=58855306914, createdName=陈SY, createdTime=Sat May 15 19:02:05 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702665, encodeId=a93f1e0266577, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Apr 23 03:51:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273383, encodeId=d15b12e33835c, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277824, encodeId=e7f412e78240d, content=<a href='/topic/show?id=e9f2e2180ef' target=_blank style='color:#2F92EE;'>#皮质醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72180, encryptionId=e9f2e2180ef, topicName=皮质醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478054, encodeId=e25614e805490, content=<a href='/topic/show?id=bb6f18030a4' target=_blank style='color:#2F92EE;'>#T细胞疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18030, encryptionId=bb6f18030a4, topicName=T细胞疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6bea7392214, createdName=124984edm24暂无昵称, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=965885, encodeId=b6fa96588516, content=博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/WrLtFUfyajK3R9Ix3ydJebbk1fUAHMlpSHneByyAx9ticmmbgGY36iaibPzg3p88N5zkF9DfXSlVsrUA8buV3etuA/132, createdBy=58855306914, createdName=陈SY, createdTime=Sat May 15 19:02:05 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702665, encodeId=a93f1e0266577, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Apr 23 03:51:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273383, encodeId=d15b12e33835c, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277824, encodeId=e7f412e78240d, content=<a href='/topic/show?id=e9f2e2180ef' target=_blank style='color:#2F92EE;'>#皮质醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72180, encryptionId=e9f2e2180ef, topicName=皮质醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478054, encodeId=e25614e805490, content=<a href='/topic/show?id=bb6f18030a4' target=_blank style='color:#2F92EE;'>#T细胞疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18030, encryptionId=bb6f18030a4, topicName=T细胞疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6bea7392214, createdName=124984edm24暂无昵称, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=965885, encodeId=b6fa96588516, content=博仁潘静医生文章还口口声声说卡提治疗过程中运用激素经验丰富,成熟。大家放心交给他们处理;不知道他们的“放心”研究结论怎么得出来的?, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/WrLtFUfyajK3R9Ix3ydJebbk1fUAHMlpSHneByyAx9ticmmbgGY36iaibPzg3p88N5zkF9DfXSlVsrUA8buV3etuA/132, createdBy=58855306914, createdName=陈SY, createdTime=Sat May 15 19:02:05 CST 2021, time=2021-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702665, encodeId=a93f1e0266577, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Apr 23 03:51:16 CST 2021, time=2021-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273383, encodeId=d15b12e33835c, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1277824, encodeId=e7f412e78240d, content=<a href='/topic/show?id=e9f2e2180ef' target=_blank style='color:#2F92EE;'>#皮质醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72180, encryptionId=e9f2e2180ef, topicName=皮质醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c279140, createdName=vividelife, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478054, encodeId=e25614e805490, content=<a href='/topic/show?id=bb6f18030a4' target=_blank style='color:#2F92EE;'>#T细胞疗法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18030, encryptionId=bb6f18030a4, topicName=T细胞疗法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6bea7392214, createdName=124984edm24暂无昵称, createdTime=Sat Feb 06 08:51:16 CST 2021, time=2021-02-06, status=1, ipAttribution=)]

相关资讯

J Dev Orig Health Dis:母婴压力之间的关系在孩子11岁时“见分晓”

近日发表在《健康与疾病发展起源》上的一项研究发现,母亲在怀孕时的压力水平与其子女在11岁时应对生活挑战的方式有关。该研究是加拿大西蒙弗雷泽大学SFU健康科学教授Pablo Nepomnaschy领导的跨学科研究团队首次完成的前瞻性队列研究。

Crit Care:脓毒性休克小儿糖皮质激素受体和皮质醇有何改变?

由此可见,该研究结果显示GCR的表达降低与脓毒性休克的不良结局相关,特别是那些血清皮质醇水平升高的患者。这与转录研究的结果一致,表明GCR信号传导基因的下调预示着更糟糕的结局。

JCEM:较低的母体皮质醇与可的松比率早于早产和足月先兆子痫临床诊断

由此可见,尽管先前报道在这些病例胎盘中11βHSD2水平降低,但是较低的母体血清皮质醇与可的松比率在先兆子痫和早产FGR的临床表现发生之前已经持续数周。该研究的结果表明在先兆子痫的病理生理学机制中母体11βHSD2活性增强或11βHSD1活性降低。

PLOS ONE:皮质醇指数对心理社会和身体健康的影响

在静止条件下对皮质醇的调节被广泛用于评估身体和心理状态,但由于可能的评估的多样性(例如,累积水平;昼夜模式),一次只考虑一个或几个会妨碍人们的理解和解释。

Lancet:治疗新型冠状病毒感染,不推荐皮质类固醇

导语:随着新型冠状病毒感染的肺炎疫情的发展,糖皮质激素作为应对重症的治疗用药在目前的四版诊疗方案中均被提及,但至今未有临床数据证明其疗效何如。今日,《柳叶刀》发表的文章就此事做出了评论:文章指出目前的临床证据并不支持使用皮质类固醇治疗新冠病毒造成的肺部损伤。

Neurology:循环皮质醇与认知和脑结构的关系

由此可见,血清中较高的皮质醇与无症状年轻人和中年人的脑容量减少和记忆受损有关,尤其是女性。