尽管托珠单抗 (TCZ) 和皮质类固醇 (CCS) 对嵌合抗原受体 (CAR) T 的影响是细胞因子释放综合征 (CRS) 和免疫效应细胞相关神经毒性综合征 (ICANS) 的主要治疗手段，但有关托珠单抗 (TCZ) 和皮质类固醇 (CCS) 影响的数据有限-多发性骨髓瘤（MM）的细胞功效。本研究旨在评估这些免疫抑制剂对 BCMA 或 GPRC5D 定向 CAR T 细胞接受者治疗复发/难治性 MM 的预后影响。我们的回顾性队列涉及 2017 年 3 月至 2023 年 3 月在单一机构接受商业或研究性自体 CAR T 细胞产品治疗的患者。主要终点是无进展生存期 (PFS)。次要终点包括总缓解率（ORR）、完全缓解率（CRR）和总生存期（OS）。总共分析了 101 名患者（91% 接受抗 BCMA CAR T 细胞治疗，9% 接受抗 GPRC5D CAR T 细胞治疗）。输注后 30 天内，34% 的患者接受了 CCS，49% 的患者接受了 TCZ 进行 CRS/ICANS 管理。在中位随访 27.4 个月时，CCS 组和非 CCS 组之间（对数秩 p = 0.35）或 TCZ 与非 TCZ 组之间（对数秩 p = 0.69）之间没有观察到 PFS 存在显着差异。评估组之间的 ORR、CRR 和 OS 也具有可比性。在我们的多变量模型中，使用 CCS 联合/不联合 TCZ 进行 CRS/ICANS 管理不会独立影响 PFS（HR，0.74；95% CI，0.36-1.51）。这些发现表明，在复发/难治性 MM 患者中，及时、适当地使用 CCS 或 TCZ 来减轻免疫介导的毒性似乎不会影响 CAR T 细胞疗法的抗肿瘤活性和长期结果。© 2024 . 作者。

Despite being the mainstay of management for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), there is limited data regarding the impact of tocilizumab (TCZ) and corticosteroids (CCS) on chimeric antigen receptor (CAR) T-cell efficacy in multiple myeloma (MM). The present study aims to evaluate the prognostic impact of these immunosuppressants in recipients of BCMA- or GPRC5D-directed CAR T cells for relapsed/refractory MM. Our retrospective cohort involved patients treated with commercial or investigational autologous CAR T-cell products at a single institution from March 2017-March 2023. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall response rate (ORR), complete response rate (CRR), and overall survival (OS). In total, 101 patients (91% treated with anti-BCMA CAR T cells and 9% treated with anti-GPRC5D CAR T cells) were analyzed. Within 30 days post-infusion, 34% received CCS and 49% received TCZ for CRS/ICANS management. At a median follow-up of 27.4 months, no significant difference in PFS was observed between CCS and non-CCS groups (log-rank p = 0.35) or between TCZ and non-TCZ groups (log-rank p = 0.69). ORR, CRR, and OS were also comparable between evaluated groups. In our multivariable model, administering CCS with/without TCZ for CRS/ICANS management did not independently influence PFS (HR, 0.74; 95% CI, 0.36-1.51). These findings suggest that, among patients with relapsed/refractory MM, the timely and appropriate use of CCS or TCZ for mitigating immune-mediated toxicities does not appear to impact the antitumor activity and long-term outcomes of CAR T-cell therapy.© 2024. The Author(s).