摘要Objective To develop a novel prognostic scoring system for severe cytokine release syndrome(CRS)in patients with B-cell acute lymphoblastic leukemia(B-ALL)treated with anti-CD19 chimeric antigen receptor(CAR)-T-cell therapy,aiming to optimize risk mitigation strategies and improve clinical management.Methods This single-center retrospective cohort study included 125 B-ALL patients who received anti-CD19 CAR-T-cell therapy from January 2017 to October 2023.These cases were selected from a cohort of over 500 treated patients on the basis of the availability of comprehensive baseline data,documented CRS grading,and at least 3 months of follow-up.Data on patient demographics,treatment history,laboratory parameters,CAR-T-cell characteristics,safety,and efficacy endpoints were collected.CRS severity was graded according to the 2019 ASTCT consensus criteria.Univariate and multivariate logistic regression analyses were conducted to identify factors associated with CRS severity,and a prognostic model was constructed.Results The overall incidence of CRS was 67.2％,with 13.6％having grade≥3(severe)CRS.Higher baseline and post-lymphodepletion minimal residual disease(MRD)levels and neutropenia on day 7 post-infusion were significantly associated with severe CRS.Inflammatory markers(CRP,ferritin,and IL-6)and coagulation dysfunction(APTT)on day 7 post-infusion were also predictive of CRS severity.The prognostic model incorporating these factors demonstrated robust discriminatory ability,with an area under the ROC curve of 0.875.Conclusion This study developed a novel prognostic scoring system for severe CRS in Chinese B-ALL patients receiving anti-CD19 CAR-T-cell therapy.The model integrates clinical and laboratory parameters to facilitate early identification and management of severe CRS.Further validation in larger,prospective cohorts is warranted.