Bone Marrow

骨髓
  • 文章类型: Journal Article
    背景:目的是提高非加速骨髓增生异常/骨髓增殖性肿瘤(MDS/MPN-U)的临床认知,避免误诊或延迟诊断。
    方法:临床表现,实验室指标,组织病理学,分析1例非加速型MDS/MPN-U患者的治疗效果并复习相关文献。
    结果:血常规:白细胞98.48x109/L,红细胞3.20x1012/L,嗜碱性粒细胞0.42x109/L,嗜酸性粒细胞1.31x109/L,血红蛋白112g/L,和血小板113×109/L血液涂片显示粒细胞缺乏和不同阶段的细胞,也可以看到多小叶粒细胞。骨髓图像显示粒细胞缺乏症和增生性中性粒细胞,例如双核粒细胞,环状核粒细胞,核冲床,细胞质液泡,多小叶粒细胞等。骨髓活检:骨髓增殖性肿瘤,结合细胞形态学和分子生物学是推荐的。基因检测显示Jak-2阳性,BCR/ABL和MPL阴性。染色体检查表明存在46,XY,添加(2)(P25),del(12)(p11.2p13)[16]/46,XY。
    结论:MDS/MPN-U伴粒细胞缺乏症和增生性中性粒细胞少见,主要是老年人,除其他髓系肿瘤外,应作出诊断。目前,没有统一的治疗指南或专家共识。治疗方案有限,需要更多的研究进一步证实。MDS/MPN-U伴粒细胞缺乏症和中性粒细胞发育不良具有不良预后因素,如高龄,骨髓原始细胞和相关基因突变的增加。不良预后是否与特定的基因突变和细胞遗传变异有关,还有待更多的研究数据来阐明。
    BACKGROUND: The goal was to improve the clinical cognition of nonaccelerating myelodysplastic/myeloproliferative neoplasms-unclassifiable (MDS/MPN-U) and avoid misdiagnosis or delayed diagnosis.
    METHODS: The clinical manifestations, laboratory indicators, histopathology, and therapeutic effects of a patient with nonaccelerating MDS/MPN-U were analyzed and the relevant literature was reviewed.
    RESULTS: Blood routine: white blood cell 98.48 x 109/L, red blood cell 3.20 x 1012/L, basophils 0.42 x 109/L, eosinophils 1.31 x 109/L, hemoglobin 112 g/L, and platelet 113 x 109/L. Blood smears showed granulocytosis and cells at various stages, polylobular granulocytes also can be seen. Bone marrow images show granulocytosis and dysplastic neutrophils, such as binuclear granulocyte, cyclic nuclear granulocyte, nuclear punch, cytoplasm vacuoles, polylobular granulocytes and so on. Bone marrow biopsy: Bone marrow proliferation tumor, combined with cell morphology and molecular biochemistry is recommended. Gene test showed Jak-2 positive, BCR/ABL and MPL negative. Chromosome examination indicated the presence of 46, XY, add (2)(p25), del (12) (p11.2p13)[16]/46, XY.
    CONCLUSIONS: MDS/MPN-U with granulocytosis and dysplastic neutrophils is rare, mostly in the elderly, and the diagnosis should be made except for other myeloid tumors. Currently, there is no uniform treatment guideline or expert consensus. The treatment options are limited and need to be further confirmed by more studies. MDS/ MPN-U with granulocytosis and dysplastic neutrophils has adverse prognostic factors such as advanced age, increase of bone marrow original cells and related gene mutations. Whether the adverse prognosis is related to specific gene mutations and cytogenetic variation remains to be clarified by more research data.
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  • 文章类型: Journal Article
    银河宇宙辐射(GCR)是宇航员在执行月球和火星任务期间面临的最严重风险之一。能够概括人体生理的实验模型对于理解辐射对人体器官的影响以及制定针对太空旅行暴露的辐射防护措施至关重要。使用包含人类骨髓(造血和急性辐射损伤部位)的工程组织模型的多器官芯片(multi-OoC)平台研究了全身辐射的影响,心肌(慢性辐射损伤部位)和肝脏(代谢部位),通过血管循环与内皮屏障相连,将各个组织腔与血管灌注液分开。在长期的中子辐射之后,深空中最具破坏性的辐射成分,与急性递送的相同累积剂量相比,观察到更大的组织功能偏差。Further,通过表征循环中的工程骨髓(eBM)衍生的免疫细胞,鉴定了58个特定于延长中子剂量效应的独特基因,与急性照射和健康组织相比。它提出,这个生物工程平台允许在“宇航员芯片”模型中研究人类对延长辐射暴露的反应,该模型可以为减轻宇宙辐射伤害的措施提供信息。
    Galactic cosmic radiation (GCR) is one of the most serious risks posed to astronauts during missions to the Moon and Mars. Experimental models capable of recapitulating human physiology are critical to understanding the effects of radiation on human organs and developing radioprotective measures against space travel exposures. The effects of systemic radiation are studied using a multi-organ-on-a-chip (multi-OoC) platform containing engineered tissue models of human bone marrow (site of hematopoiesis and acute radiation damage), cardiac muscle (site of chronic radiation damage) and liver (site of metabolism), linked by vascular circulation with an endothelial barrier separating individual tissue chambers from the vascular perfusate. Following protracted neutron radiation, the most damaging radiation component in deep space, a greater deviation of tissue function is observed as compared to the same cumulative dose delivered acutely. Further, by characterizing engineered bone marrow (eBM)-derived immune cells in circulation, 58 unique genes specific to the effects of protracted neutron dosing are identified, as compared to acutely irradiated and healthy tissues. It propose that this bioengineered platform allows studies of human responses to extended radiation exposure in an \"astronaut-on-a-chip\" model that can inform measures for mitigating cosmic radiation injury.
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  • 文章类型: English Abstract
    Objective: To explore the correlation of bone marrow polychonal plasma cell proportion (pPC% ) and clinical features in newly diagnosed multiple myeloma (NDMM) patients. Methods: A retrospective analysis of 317 patients with NDMM admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2018 to January 2023 was performed. The results of the pPC% in all patients were clear. The relationship between the pPC% and clinical characteristics was analyzed. Results: A total of 317 patients were included, comprising 180 males and 137 females. The median age at diagnosis was 61 (26-91) years, and 55.8% were 60 years or older. The pPC% in the bone marrow of patients with NDMM was different in the DS, International Staging System (ISS), and revised ISS (R-ISS) stages (P=0.002, 0.010, and 0.049, respectively), whereas no statistical difference in pPC% was observed among patients with different FISH risk stratigrams (P=0.971). The correlation coefficient between pPC% and hemoglobin (HGB) at the first diagnosis in patients was 0.211 (P<0.01). The correlation coefficients with serum calcium, serum creatinine, M protein level, and β(2)-microglobulin were -0.141, -0.120, -0.181, and -0.207, respectively, and the results of the significance test were P=0.012, 0.033, 0.004, and 0.002, respectively, indicating a negative correlation. Compared with the patients with a pPC% of ≥2.5%, the group of patients with a pPC% of <2.5% had significantly higher levels of light chain, serum calcium, serum creatinine, M protein, and β(2)-microglobulin at the initial diagnosis (P<0.05) ; lower HGB level (P<0.001) ; and a higher proportion of patients in ISS stage Ⅲ (P=0.034) . Conclusion: In this study, the pPC% in patients with NDMM was associated with clinical features of good prognosis, including higher HGB, lower serum calcium, serum creatinine, M protein quantity, β(2)-microglobulin, light chain involvement, lower proportion of advanced disease (DS stage and ISS stage Ⅲ), and clinical features showing lower tumor burden.
    目的: 探究初诊多发性骨髓瘤(NDMM)患者骨髓多克隆浆细胞占比(pPC%)与临床特征的相关性。 方法: 回顾性分析2018年1月至2023年1月在华中科技大学同济医学院附属同济医院收治的317例NDMM患者,纳入患者均有明确的pPC%结果。分析pPC%与临床特征的关系。 结果: 共纳入317例患者,其中男180例,女137例,中位确诊年龄61(26~91)岁,≥60岁患者占55.8%。NDMM患者骨髓pPC%在各DS分期、ISS分期、R-ISS分期组差异均有统计学意义(P值分别为0.002、0.010、0.049),而不同的FISH危险分层患者pPC%差异无统计学意义(P=0.971)。NDMM患者pPC%与患者初诊时HGB呈正相关(r=0.211,P<0.01);与血钙、血肌酐、单克隆免疫球蛋白(M蛋白)定量、β(2)微球蛋白水平呈负相关(r分别为-0.141、-0.120、-0.181、-0.207,P值为0.012、0.033、0.004、0.002)。与pPC%≥2.5%患者相比,pPC%<2.5%组患者初诊时受累轻链、血钙、血肌酐、M蛋白和β(2)微球蛋白水平明显升高(P值均<0.05),HGB降低(P<0.001),ISS分期Ⅲ期比例更高(P=0.034)。 结论: NDMM患者pPC%与良好预后的临床特征相关,包括更高的HGB,更低的血钙、血肌酐、M蛋白定量、β(2)微球蛋白,受累轻链,更低的晚期疾病占比(DS分期、ISS分期Ⅲ期),在临床特点上表现为肿瘤负荷较小。.
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  • DOI:
    文章类型: Journal Article
    使用帕金森氏病(PD)的鱼藤酮模型并随后施用细菌黑色素(BM),对大鼠的脑黑质(SNc)和骨髓的微血管的形态和功能状态进行了比较研究。根据Chilingaryan的组织血管学方法进行微血管系统的检测。使用圆筒试验研究动物行为。对形态测量数据的分析表明,与对照动物相比,鱼藤酮功能障碍的实验动物显示出毛细血管直径的增加和SNc中毛细血管连接的普遍减少。行为测试表明,鱼藤酮中毒的动物表现出PD固有的行为形式(冷冻,不动,冷漠)。在BM的影响下,SNc中毛细血管的直径接近标准,毛细管连接恢复。由于BM对鱼藤酮中毒大鼠的保护作用,由于血管腔接近常态和毛细血管网络中新分支的开放,脑组织的营养增加,毛细血管密度的增加,确保神经细胞的安全。动物行为指标接近正常。还对大鼠骨髓的细胞遗传学数据进行了综合分析。在有PD的动物中,与对照组相比,多倍体细胞(PC)的数量显着增加,有丝分裂指数(MI)的水平降低,通常表现在炎症过程中,并伴有骨髓造血的抑制。在BM的影响下,注意到MI正常化的趋势,并获得PC百分比的显着降低,这可能表明它的有益效果。获得的数据表明BM可以用作治疗PD的治疗剂。
    A comparative study of the morphological and functional state of the microvasculature of the substantia nigra pars compacta of the brain (SNc) and bone marrow of rats was carried out using the rotenone model of Parkinson\'s disease (PD) and with subsequent administration of bacterial melanin (BM). The detection of microvasculature was carried out according to the histoangiological method of Chilingaryan. Animal behavior was studied using a cylinder test. An analysis of morphometric data showed that, in comparison with control animals, experimental animals with rotenone dysfunction showed an increase in capillary diameters and a general reduction in the capillary link in SNc. Behavioral tests have shown that the animals with rotenone intoxication exhibit a form of behavior inherent in PD (freezing, immobility, apathy). Under the influence of BM, the diameter of the capillaries in the SNc approaches the norm, and the capillary link is restored. Due to the protective effect of BM in rats with rotenone intoxication, the trophism of the brain tissue increases as a result of the approach of the lumen of the vessels to the norm and the opening of new branches in the capillary network, an increase in the density of capillaries, which ensures the safety of nerve cells. Animal behavior indicators are close to normal. A comprehensive analysis of cytogenetic data of rat bone marrow was also carried out. In animals with PD, compared to controls, there is a significant increase in the amount of polyploid cells (PC) and a decrease in the level of mitotic index (MI), which usually manifests itself in inflammatory processes and is accompanied by inhibition of bone marrow hematopoiesis. Under the influence of BM, a tendency towards normalization of MI was noted and a significant decrease in the percentage of PC was obtained, which possibly indicates its beneficial effect. The data obtained suggest that BM can be used as a therapeutic agent in the treatment of PD.
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  • 文章类型: Journal Article
    目的:已知移植前肺功能障碍是异基因造血细胞移植(allo-HCT)后非复发死亡率(NRM)的危险因素。尚不清楚哪种细胞来源对肺功能障碍患者具有更好的预后。
    方法:我们分析了3289名接受HLA匹配的allo-HCT的标准风险疾病成人患者,并比较接受外周血干细胞(PBSC)与根据造血细胞移植特异性合并症指数(HCT-CI)的肺评分,两个队列中的骨髓(BM):肺评分(LS)和非LS队列。
    结果:在LS队列中,BM组的2年总生存率(OS)高于PBSC组(72.4%vs.61.4%;P=0.044)。在非LS队列中,两组之间没有显着差异(71.7%vs.73.2%;P=0.13)。多变量分析证实,在LS队列中,PBSC与不良OS显著相关(风险比[HR],1.66;95%CI,1.09-2.54;P=0.019)。另一方面,细胞来源不影响非LS队列中的OS(HR,0.92;95%CI,0.76-1.12;P=0.41)。我们发现,在LS队列中,PBSC与NRM风险增加相关(HR,2.17;95%CI,1.16-4.05;P=0.016),而细胞来源对非LS队列中的NRM没有显著影响。在这两个队列中,PBSC均未被确定为复发的危险因素。
    结论:我们的结果表明,在HLA匹配的allo-HCT中,BM可能对肺功能障碍的受体有益。
    OBJECTIVE: Pre-transplant lung dysfunction is known to be a risk factor for non-relapse mortality (NRM) after allogeneic hematopoietic cell transplantation (allo-HCT). It is unclear which cell source gives better outcomes for patients with pulmonary dysfunction.
    METHODS: We analyzed 3289 adult patients with standard-risk disease who had received HLA-matched allo-HCT, and compared outcomes between those who received peripheral blood stem cell (PBSC) vs. bone marrow (BM) in two cohorts based on the presence of a lung score by the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI): the Lung-scored (LS) and non-LS cohorts.
    RESULTS: In the LS cohort, the 2-year overall survival (OS) in the BM group tended to be higher than that in the PBSC group (72.4% vs. 61.4%; P = 0.044). In the non-LS cohort, there was no significant difference between the two groups (71.7% vs. 73.2%; P = 0.13). Multivariate analyses confirmed that PBSC was significantly associated with inferior OS in the LS cohort (hazard ratio [HR], 1.66; 95% CI, 1.09-2.54; P = 0.019). On the other hand, the cell source did not affect OS in the non-LS cohort (HR, 0.92; 95% CI, 0.76-1.12; P = 0.41). We found that PBSC was associated with an increased risk of NRM in the LS cohort (HR, 2.17; 95% CI, 1.16-4.05; P = 0.016), while the cell source did not significantly affect NRM in the non-LS cohort. PBSC was not identified as a risk factor for relapse in either cohort.
    CONCLUSIONS: Our results suggest that BM might be beneficial for recipients with lung dysfunction in HLA-matched allo-HCT.
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  • 文章类型: Journal Article
    Morgana是由CHORDC1基因编码的一种普遍存在的HSP90共伴侣蛋白。Morgana杂合子小鼠随着年龄的增长而发展为类似人类非典型骨髓性白血病(aCML)的骨髓性恶性肿瘤,现在更名为MDS/MPN与中性粒细胞增多症。受此病理影响的患者在骨髓(BM)中表现出低Morgan水平,这表明Morgana下调在人类恶性肿瘤中起着致病作用。在费城阳性(Ph)慢性髓性白血病(CML)患者的一组BM中,Morgan表达水平的降低也很明显,对伊马替尼具有耐药性或不完全反应。尽管这些数据具有相关性,患者骨髓中Morgana表达下调的机制尚不清楚。在这项研究中,我们研究了Morgana表达受miRNA调控的可能性,并证明了Morgana在4种miRNA(miR-15a/b和miR-26a/b)的控制下,miR-15a可能是CML患者Morgana下调的原因.
    Morgana is a ubiquitous HSP90 co-chaperone protein coded by the CHORDC1 gene. Morgana heterozygous mice develop with age a myeloid malignancy resembling human atypical myeloid leukemia (aCML), now renamed MDS/MPN with neutrophilia. Patients affected by this pathology exhibit low Morgana levels in the bone marrow (BM), suggesting that Morgana downregulation plays a causative role in the human malignancy. A decrease in Morgana expression levels is also evident in the BM of a subgroup of Philadelphia-positive (Ph+) chronic myeloid leukemia (CML) patients showing resistance or an incomplete response to imatinib. Despite the relevance of these data, the mechanism through which Morgana expression is downregulated in patients\' bone marrow remains unclear. In this study, we investigated the possibility that Morgana expression is regulated by miRNAs and we demonstrated that Morgana is under the control of four miRNAs (miR-15a/b and miR-26a/b) and that miR-15a may account for Morgana downregulation in CML patients.
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  • 文章类型: Journal Article
    以0.25、0.5和1mg/kg的单剂量腹膜内施用拓扑替康,以剂量依赖性方式在F1(CBA×C57BL/6)杂交小鼠的骨髓细胞中诱导染色体畸变。酪氨酰-DNA磷酸二酯酶1(TDP1)抑制剂,松果酸衍生物OL9-116在20-240mg/kg的剂量范围内无活性,但在40mg/kg(每个操作系统)的剂量下增强了托泊替康(0.25mg/kg)的细胞遗传学作用。TDP1抑制剂,香豆素衍生物TX-2552(剂量为20、40、80和160mg/kg/s),托泊替康(0.25mg/kg)诱导的异常中期水平增加2.1-2.6倍,但在10mg/kg的剂量下无活性。结果表明,TDP1抑制剂可增强托泊替康在体内小鼠骨髓细胞中的致裂活性,并以不同剂量的共致突变作用为特征。
    Topotecan administered intraperitoneally at single doses of 0.25, 0.5, and 1 mg/kg induced chromosomal aberrations in bone marrow cells of F1(CBA×C57BL/6) hybrid mice in a dose-dependent manner. A tyrosyl-DNA phosphodiesterase 1 (TDP1) inhibitor, an usnic acid derivative OL9-116 was inactive in a dose range of 20-240 mg/kg, but enhanced the cytogenetic effect of topotecan (0.25 mg/kg) at a dose of 40 mg/kg (per os). The TDP1 inhibitor, a coumarin derivative TX-2552 (at doses of 20, 40, 80, and 160 mg/kg per os), increased the level of aberrant metaphases induced by topotecan (0.25 mg/kg) by 2.1-2.6 times, but was inactive at a dose of 10 mg/kg. The results indicate that TDP1 inhibitors enhance the clastogenic activity of topotecan in mouse bone marrow cells in vivo and are characterized by different dose profiles of the co-mutagenic effects.
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  • 文章类型: Journal Article
    棕色和棕色样脂肪组织因其在糖尿病和肥胖症的代谢和治疗潜力中的作用而引起了广泛关注。尽管有令人信服的证据表明脂肪细胞和淋巴细胞之间存在相互作用,这些组织在免疫反应中的参与在很大程度上仍未被探索。这项研究阐明了神经炎症与棕色和骨髓脂肪组织之间的新发现的联系。利用[18F]F-AraG,能够同时追踪活化淋巴细胞和脂肪细胞的线粒体代谢示踪剂,我们展示,在胶质母细胞瘤和多发性硬化症的模型中,脑内免疫浸润与棕色和骨髓脂肪组织变化的相关性。重要的是,我们提供了初步证据,表明人类也可能存在神经炎症-脂肪组织联系。这项研究提出了一个复杂的免疫-神经-脂肪回路的概念,并强调棕色和骨髓脂肪组织是免疫系统和神经系统之间交流的中介。了解此电路内的互连性可能会导致各种疾病的治疗和管理的进步,包括癌症,神经退行性疾病和代谢紊乱。
    Brown and brown-like adipose tissues have attracted significant attention for their role in metabolism and therapeutic potential in diabetes and obesity. Despite compelling evidence of an interplay between adipocytes and lymphocytes, the involvement of these tissues in immune responses remains largely unexplored. This study explicates a newfound connection between neuroinflammation and brown- and bone marrow adipose tissue. Leveraging the use of [18F]F-AraG, a mitochondrial metabolic tracer capable of tracking activated lymphocytes and adipocytes simultaneously, we demonstrate, in models of glioblastoma and multiple sclerosis, the correlation between intracerebral immune infiltration and changes in brown- and bone marrow adipose tissue. Significantly, we show initial evidence that a neuroinflammation-adipose tissue link may also exist in humans. This study proposes the concept of an intricate immuno-neuro-adipose circuit, and highlights brown- and bone marrow adipose tissue as an intermediary in the communication between the immune and nervous systems. Understanding the interconnectedness within this circuitry may lead to advancements in the treatment and management of various conditions, including cancer, neurodegenerative diseases and metabolic disorders.
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  • 文章类型: Journal Article
    Bone marrow biopsy is one of the important means of hematopathological diagnosis, which has decisive diagnostic significance for various benign and malignant lymphohematopoietic system diseases. Its diagnostic value includes morphological observation, immunohistochemistry, genetics, and molecular biology testing. Owing to the unique nature of bone marrow biopsy, decalcification is an essential step in the pre-treatment process. Its purpose is to remove calcium from bone tissue, preserve intact collagen fiber components, facilitate tissue sectioning, and prevent tissue detachment during staining. If bone marrow biopsy lacks sufficient decalcification, preparing a section is difficult. Conversely, if decalcification is excessive, it can seriously disrupt tissue antigen activity. Therefore, a decalcification method with high decalcification efficiency and mild antigen damage is essential for bone marrow biopsy. This article introduces a bone marrow biopsy tissue decalcification method with high efficiency and less antigen loss: decalcification is performed at room temperature with 12% formic acid and 8% hydrochloric acid decalcification solution on a shaker.
    骨髓活检是血液病理诊断的重要手段之一,对于多种良、恶性淋巴造血系统疾病均具有决定性的诊断意义,其诊断价值包括形态学观察,以及免疫组化、遗传学和分子生物学等辅助检测。由于骨髓活检组织本身的特殊性,脱钙是前期处理过程中必不可少的环节,其目的是将骨组织中钙盐去掉,保留完整的胶原纤维成分,以利于组织切片以及避免染色时掉片。如果骨髓活检脱钙不充分,则难以制片,但如果脱钙过度,又会严重破坏组织抗原活性,因此,一种脱钙效率高且抗原破坏小的脱钙方法对于临床病理骨髓活检十分重要。本文介绍一种高效且抗原破坏较小的骨髓活检组织脱钙方法:12%甲酸-8%盐酸脱钙液室温摇床脱钙,供广大同仁参考和指正。.
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  • 文章类型: English Abstract
    Objective: The effect of bone marrow soluble B cell maturation antigen (sBCMA) expression on the efficacy and side effects of chimeric antigen receptor (CAR) -modified T-cell-targeting B cell maturation antigen (BCMA) in patients with multiple myeloma (MM) . Methods: This study involved 29 patients with relapsed or refractory MM (RRMM) who received humanized anti-BCMA CAR-T cell clinical trials from January 2018 to December 2021. The expression of sBCMA in bone marrow before and after anti-BCMA CAR-T cell treatment was detected by flow cytometry and compared. Results: ①Two months after BCMA CAR-T cell treatment, 20 patients (68.97%) achieved an overall response (OR), whereas nine patients had stable disease (SD) or miner emission (MR). ②The expression of sBCMA in the bone marrow of 20 patients with OR was higher before treatment than after [26 926 (18 215, 32 488) ng/L vs 9 968 (6 634, 11 459) ng/L; P<0.001]; no significant difference was observed in patients with MR and SD [41 187 (33 816, 47 046) ng/L vs. 33 954 (31 569, 36 256) ng/L; P=0.145]; sBCMA expression in patients with OR before CAR-T cell treatment was lower than in patients with MR and SD (P=0.005). ③No significant linear correlation was found between the peak value of CAR-T cells and sBCMA expression in the bone marrow of all 29 patients with RRMM (R(2)=0.035, P=0.330). ④No significant difference in sBCMA expression was found between grades 0-1 CRS group (13 patients) and grades 2-4 CRS group [16 patients; 32 045 (18 742, 40 801) ng/L vs 29 102 (24 679, 38 776) ng/L, P=0.879], nor between grade 0 ICANS group (22 patients) and grade 1-3 ICANS group [seven patients; 30 073 (19 375, 40 065) ng/L vs 33 816 (22 933, 43 459) ng/L, P=0.763]. Conclusion: sBCMA expression in the bone marrow is related to the efficacy of BCMA CAR-T cell therapy in patients with RRMM, but is not significantly correlated with the severity of adverse events. It may serve as a predictive biomarker for the efficacy of BCMA CAR-T cell therapy in these patients.
    目的: 探索多发性骨髓瘤(MM)患者骨髓可溶性B细胞成熟抗原(sBCMA)表达对靶向B细胞成熟抗原(BCMA)的嵌合抗原受体T细胞(CAR-T细胞)治疗疗效及安全性的影响。 方法: 以2018年1月至2021年12月接受人源化抗BCMA CAR-T细胞临床试验的29例复发/难治MM(RRMM)患者为研究对象。流式细胞术检测抗BCMA CAR-T细胞治疗前后骨髓sBCMA的表达并进行差异比较。 结果: ①BCMA CAR-T细胞治疗2个月,20例(68.97%)患者获得总体反应(OR),9例患者仅为病情稳定(SD)或微小缓解(MR)。②20例OR组患者骨髓sBCMA表达治疗前高于治疗后[26 926(18 215, 32 488)ng/L对9 968(6 634, 11 459)ng/L,P<0.001];而MR+SD组患者骨髓sBCMA表达治疗前后差异无统计学意义[41 187(33 816, 47 046)ng/L对33 954(31 569, 36 256)ng/L,P=0.145];CAR-T细胞治疗前骨髓sBCMA表达OR组低于MR+SD组患者(P=0.005)。③全部29例RRMM患者CAR-T细胞峰值与骨髓sBCMA表达无明显线性相关性(R(2)=0.035,P=0.330)。④sBCMA表达水平与CAR-T细胞治疗不良事件严重程度的相关性:0~1级细胞因子释放综合征(CRS)组(13例)与2~4级CRS组(16例)比较骨髓sBCMA表达差异无统计学意义[32 045(18 742, 40 801)ng/L对29 102(24 679, 38 776)ng/L,P=0.879];0级免疫效应细胞相关神经毒性综合征(ICANS)组(22例)与1~3级ICANS组(7例)比较骨髓sBCMA表达差异无统计学意义[30 073(19 375, 40 065)ng/L对33 816(22 933, 43 459)ng/L,P=0.763]。 结论: 骨髓sBCMA表达与RRMM患者接受BCMA CAR-T细胞治疗的疗效有关,但与不良事件严重程度无显著相关性。或可作为RRMM患者接受BCMA CAR-T细胞治疗的疗效预测标志物。.
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