摘要目的 探讨CAR-T细胞治疗中枢神经系统白血病(CNSL)的有效性和安全性.方法 报道两例合并CNSL白血病患者抗CD 19 CAR-T细胞治疗的过程及结果,并对相关文献进行复习.结果 两例患者骨髓细胞形态学特征分别为伴B淋系表达的急性髓系白血病(AML)-M2和急性B淋巴细胞白血病(B-ALL),免疫分型符合AML-M2和B-ALL的异常表现,临床和实验室检查符合CNSL诊断标准,诊断明确后予以抗CD 19 CAR-T细胞治疗,输注总量均为5.0×106/kg.回输后两例患者中枢神经系统症状缓解.例l影像学异常消失,治疗过程中出现细胞因子释放综合征(CRS),药物干预后好转;例2脑脊液微小残留病转阴,未出现明显CRS反应.结论 CAR-T细胞治疗有望缓解CNSL,改善患者预后.

abstractsObjective To explore the efficacy and safety of chimeric antigen receptor T (CAR-T) cells in the treatment of central nervous system leukemia (CNSL).Methods Two leukemia patients with CNSL were treated with CD 19-CAR-T cells.The process and results of the entire treatment is reported and related literature review is conducted.Results The patients were diagnosed as acute myeloid leukemia (AML)-M2 with B lymphoid antigen expression and B cell acute lymphoblastic leukemia(B-ALL) by morphology and immunophenotype assay.The immunophenotype was consistent with the abnormal manifestations of AML-M2 and B-ALL.Their clinical manifestations and laboratory tests met the diagnostic criteria of CNSL.The diagnosis was clear and the two patients were treated with CD19-CAR-T cell immunotherapy.Central nervous system symptoms were relieved.The imaging abnormalities of patient one has disappeared but cytokines release syndrome (CRS) occurred during the treatment.Cerebrospinal fluid of patient two was negative and no obvious CRS reaction was found.Conclusions CAR-T cell immunotherapy is likely to induce the remission of CNSL and improve the prognosis.