骨髓细胞形态学联合Hb/RDW比值评估DLBCL CAR-T治疗失败的价值

doi:10.3760/cma.j.cn441417-20240730-08027

摘要/Abstract

摘要：

目的　探讨骨髓细胞形态学联合血红蛋白（hemoglobin，Hb）/红细胞分布宽度（red blood cell distribution width，RDW）比值评估弥散大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）嵌合抗原受体T细胞（chimeric antigen receptor T-cell，CAR-T）治疗失败的价值。方法　选取2022年2月至2023年12月咸阳市中心医院收治的88例DLBCL患者为研究对象。所有患者均接受CD19 CAR-T治疗，随访6个月，根据随访结果分为治疗成功组39例［男20例，女19例，年龄（57.35±7.93）岁］和治疗失败组49例［男26例，女23例，年龄（58.09±8.53）岁］。比较两组骨髓细胞形态学和Hb/RDW比值。构建受试者操作特征曲线（receiver operating characteristic curve，ROC）评估骨髓细胞形态学和Hb/RDW比值预测DLBCL CAR-T治疗失败的价值。采用t检验、χ²检验进行统计分析。结果　治疗成功组细胞体积大于2倍普通淋巴细胞体积、细胞形态呈不规则形、有伪足或突起、胞浆存在核周淡染区、细胞核呈不规则形、有多核情况、有瘤细胞聚集存在的比例低于治疗失败组［35.90%（14/39）比79.59%（39/49）、17.95（7/39）比75.51%（37/49）、38.46%（15/39）比65.31%（32/49）、5.13%（2/39）比24.49%（12/49）、15.38（6/39）比81.63%（40/49）、0比16.33%（8/49）、0比24.49%（12/49）］，差异均有统计学意义（χ²=17.308、28.781、6.289、6.085、38.202、7.004、11.059，均P<0.05）。治疗失败组Hb/RDW比值低于治疗成功组［（0.79±0.18）比（1.04±0.21），差异有统计学意义（t=6.010，P<0.001）］。骨髓细胞形态学、Hb/RDW比值及两者联合评估DLBCL患者CAR-T治疗失败的Kappa值分别为0.657、0.426和0.861。结论　骨髓细胞形态学联合Hb/RDW比值评估DLBCL CAR-T治疗失败具有潜在的临床应用价值。低Hb/RDW比值可能是评估CAR-T治疗失败的一个重要指标。

关键词:

骨髓细胞形态学, 血红蛋白, 红细胞分布宽度, 弥散大B细胞淋巴瘤, CAR-T治疗

Abstract:

Objective　To explore the value of bone marrow cell morphology combined with hemoglobin (Hb)/red blood cell distribution width (RDW) ratio in the assessment of treatment failure in patients with diffuse large B-cell lymphoma (DLBCL) undergoing chimeric antigen receptor T-cell (CAR-T) therapy. Methods　Between February 2022 and December 2023, 88 patients with DLBCL treated by CD19 CAR-T cell therapy at Xianyang Central Hospital were selected as the study objects, and were followed up for six months. Based on the follow-up results, the patients were divided into a successful treatment group (39 cases) and a treatment failure group (49 cases). The bone marrow cell morphology and Hb/RDW ratios were compared between the two groups. The receiver operating characteristic curves (ROC) were constructed to evaluate the diagnostic value of bone marrow cell morphology and Hb/RDW ratio for identifying DLBCL CAR-T treatment failure. t and χ² tests were used for the statistical analysis. Results　The proportions of the patients with large cell size (more than twice the normal lymphocyte size), irregular cell morphology, presence of pseudopodia or protrusions, perinuclear pale staining areas in the cytoplasm, irregular cell nuclei, multinucleation, and tumor cell aggregation in the successful treatment group were lower than those in the treatment failure group [35.90% (14/39) vs. 79.59% (39/49), 17.95% (7/39) vs. 75.51% (37/49), 38.46% (15/39) vs. 65.31% (32/49), 5.13% (2/39) vs. 24.49% (12/49), 15.38% (6/39) vs. 81.63% (40/49), 0 vs. 16.33% (8/49), and 0 vs. 24.49% (12/49)], with statistical differences (χ²=17.308, 28.781, 6.289, 6.085, 38.202, 7.004, and 11.059; all P<0.05). The treatment failure group had a lower Hb/RDW ratio than the successful treatment group (0.79±0.18 vs. 1.04±0.21), with a statistical difference (t=6.010; P<0.001). The Kappa values in the assessment of treatment failure in the patients by the bone marrow cell morphology, Hb/RDW ratio, and the combination of both were 0.657, 0.426, and 0.861, respectively. Conclusion　Bone marrow cell morphology combined with Hb/RDW ratio in the assessment of CAR-T treatment failure in patients with DLBCL has potential clinical value. A low Hb/RDW ratio may be an important indicator of CAR-T treatment failure.

Key words:

Bone marrow cell morphology, Hemoglobin, Red blood cell distribution width, Diffuse large B-cell lymphoma, CAR-T treatment

卫晓娟李新锋郭团茂.

骨髓细胞形态学联合Hb/RDW比值评估DLBCL CAR-T治疗失败的价值 [J]. 国际医药卫生导报, 2025, 31(8): 1364-1368.

Wei Xiaojuan, Li Xinfeng, Guo Tuanmao.

Value of bone marrow cell morphology combined with hemoglobin/red blood cell distribution width ratio in assessment of failure of CAR-T therapy for diffuse large B-cell lymphoma [J]. International Medicine and Health Guidance News, 2025, 31(8): 1364-1368.

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