| Objective: Analysis of the safety and clinical efficacy of chimeric antigen receptor T cell in the treatment of elderly patients with hematologic malignancies and the effect of clinical factors on safety and clinical efficacy.Methods: A retrospective study was conducted to collect the clinical data of 23 elderly patients with hematological malignancies treated by chimeric antigen receptor T cells from March 2016 to October 2017 in our medical center.The related adverse events and remission rate within 28 days after CAR-T cell infusion were analyzed.Results: The median age of enrolled patients was 64(range from 60 to74 years old.The ratio of male: female was 14:9.Adverse events related to CAR-T treatment occurred in elderly(86.9%)patients,while incidence of grade>2 CRS was 34.7%,8.7% patients received treatment of tocilizumab,and 8.7% patients received steroid therapy to control CRS.The incidence of adverse reactions involving nervous system was 8.7%,and no patients suffered cerebral edema after active supportive care.CAR-T cells were detected to be capable of keep expanding in vivo for 18 months.The total remission rate by which the results of laboratory testing of blood,bone marrow and cerebrospinal fluid(CSF),as well as physical examination was 73.9% at least 28 days.The remission rate tested by multiparameter flow cytometry within 28 days was 34.8%.The rate of disease-free survival(DFS)was 60% during follow-up of 6 months,and 33.3% at 12 months of follow-up.The overall survival(OS)rate was 100% at the end of the follow-up period,and the median remission duration was not reached.Conclusion: The results of our preliminary study indicate that CAR-T related adverse events in elderly patients with hematological malignancies are both transient,controllable,well tolerated and effective.CAR-T therapy is a treatment option for elderly patients who are not suitable for traditional therapy of hematological malignancies. |
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