| Objective:Diffuse large B-cell lymphoma is the non Hodgkin’s lymphoma with the highest incidence rate in the world.After first-line treatment,30%-40%of DLBCL patients eventually relapse,and about 10%-15%are refractory diseases.Now,the immunotherapy of chimeric antigen receiving T cells(car-t therapy)can be used as a new therapy after chemotherapy is ineffective.Clinical studies have shown that car-t treatment has a common syndrome.This syndrome is cytokine release syndrome(CRS),which is mainly manifested by obvious reactions such as fever,hypooxia,hypotension and electrolyte disturbance after car-t cell infusion.This toxic reaction will cause disturbance of the immune system and release high levels of pro-inflammatory cytokines.On this basis,how to improve the long-term effective survival time of the killer cells after car-t treatment and reduce the related toxic and side effects are the problems facing the clinic.The purpose of this study is to preliminarily explore the relationship between immunotherapy of chimeric antigen receptor T cells and traditional Chinese medicine.Significance:CRS is the biggest obstacle that car-t cell therapy cannot have a further effect on lymphoma at present.Explore the possibility that traditional Chinese medicine can treat the CRS reaction caused by car-t treatment,and then help car-t improve the curative effect.However,at present,there is no paper or clinical trial indicating that traditional Chinese medicine is involved in the car-t treatment of lymphoma,and this field is still completely blank.The diagnosis and treatment of diseases in traditional Chinese medicine is first based on the differentiation of symptoms,determine the basic symptoms of patients,and then treat and use drugs.Therefore,it is necessary to clarify the basic situation of TCM Syndromes of lymphoma patients after car-t treatment and explore the essence of TCM syndrome changes during car-t treatment.Research methods:First,formulate the TCM syndrome collection scheme:take cart treatment,diffuse large B-cell lymphoma,lymphoma,relapsed/refractory lymphoma,cytokine release syndrome,etc.as the keywords,search the literature,and formulate the TCM syndrome collection scheme for car-t cell therapy according to the lymphoma syndrome types recorded in the TCM literature.Clinical part of traditional Chinese medicine:51 effective patient data were collected.All patients received car-t treatment,and completed clinical observation and auxiliary treatment after car-t cell transfusion during hospitalization.Observe and analyze TCM symptoms.Clinical part of Western medicine:the patients who received car-t treatment in the adult lymphoma ward of Beijing Boren hospital were collected.All patients were diagnosed pathologically and received car-t treatment.During the treatment,the CRS response and prognosis of the patients were observed,and the relevant data were statistically analyzed.Results:In this study,a TCM syndrome collection scheme was developed.The TCM research part collected 51 patient data,including 27 females and 24 males,with a median age of 51.The patients were grouped and analyzed according to their age.The 51 patients were involved in 31 kinds of TCM symptoms,of which the top 5 were poor appetite,fatigue,lack of breath and lazy speech,expectoration and poor sleep.According to the syndrome differentiation of tongue and pulse,the top five TCM syndromes are Qi deficiency,spleen deficiency,phlegm dampness,yin deficiency and blood stasis.After receiving car-t treatment,44 febrile patients all experienced fatigue and increased anorexia on the original basis after their body temperature fluctuated,and experienced sleep problems of different degrees.Some patients experienced symptoms such as headache,oral ulcer,local edema,emotional anxiety,dry mouth and bitter mouth.In the clinical data of Western medicine,according to the CRS grading of patients after car-t transfusion,the relevant data of CRS grading and curative effect of patients were statistically analyzed,and the statistical relationship between the number of car-t cells in the body,hormone medication and curative effect within two months after car-t cell transfusion was analyzed.Conclusion:Spleen deficiency,Qi deficiency,blood stasis and phlegm dampness are the main syndromes in the patient group.There is no significant statistical difference in the overall TCM syndrome distribution before and after car-t treatment.However,from the self comparison before and after each patient,it was found that the symptoms of spleen deficiency were aggravated.After car-t treatment,there was no obvious organ toxic injury reaction in the whole process.Besides fever,there was no vomiting,alopecia and other reactions.Most of the fever can be controlled in time with drugs.Compared with the damage of radiotherapy and chemotherapy drugs to the patients themselves,the clinical syndrome changes of patients during car-t treatment are more similar to the deficiency and depletion of healthy qi in the human body.When analyzing the relationship between CRS grade and the therapeutic effect of car-t,the statistical results show that CRS grade has an impact on the survival time,while CRS grade may be related to age factors,and there is no obvious correlation between CRS grade and car-t cell peak index,expansion peak time and in vivo duration;The higher the amplification peak of car-t cells,the better the clinical efficacy;The application of hormones is still worth further discussion;IL-6、IL-10、CD25、TNF-α And TNF-γZ these 5 cytokines are highly consistent with the clinical response of CRS. |
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