目的：观察托珠单抗治疗嵌合抗原受体修饰的T(CAR-T)细胞治疗难治复发多发性骨髓瘤（multiple myeloma，MM）后细胞因子释放综合征（cytokine release syndrome, CRS）的疗效。 方法： 以2016年2月至2017年2月西安交通大学第二附属医院血液内科住院的24例CAR-T细胞治疗难治复发MM患者为研究对象，对发生2级以上的CRS患者给予4~8 mg/ （kg·d）的托珠单抗治疗，观察其疗效及毒副作用、细胞因子、超敏C反应蛋白(HsCRP)等的变化。 结果： 24例患者中有21例患者发生了CRS，依据CRS分级标准：1、2级各7例，3级5例，4级2例。CRS患者均表现持续高热，细胞因子及HsCRP明显升高，其中IL-6升高最为显著。14例2级以上CRS患者经托珠单抗治疗后，临床症状明显缓解、体温迅速下降，细胞因子、HsCRP含量逐渐恢复正常，无明显毒副作用发生。 结论： 托珠单抗在CRS治疗中疗效明显、无明显毒副作用，保证了难治复发MM患者CAR-T治疗的安全性。

Objective: To observe the therapeutic effect of tocilizumab on cytokine release syndrome (CRS) for pa-tients with relapsed or refractory multiple myeloma (MM) treated by CAR-T cell immunotherapy. Methods: From February 2016 to February 2017, 24 patients with relapsed or refractory multiple myeloma treated by CAR-T cell immunotherapy in the Department of Hematology of Second Affiliated Hospital of Medical College, Xi’an Jiaotong University were included as study subjects. Tocilizumab (4-8 mg/kg·d) was applied on MM patients with grade 2 or above , and the treatment efficacy, side effects, and the changes of hypersensitive C-reactive protein (HsCRP) etc were observed. Results: Twenty-one of the 24 patients suffered from CRS during the CAR-T treatment. According to the CRS classification criteria, 7 patients had grade 1 CRS reaction, 7 patients with grade 2, 5 patients with grade 3, and 2 patients with grade 4. The manifestations of CRS were hyperpyrexia, significant increase in cytokines and HsCRP level with the most obvious increase in IL-6. Fourteen CRS patients with grade 2 or above were treated by tocilizumab and their clinical symptoms were obviously alleviated: the temperature was rapidly decreased and cyto-kines and hypersensitive C-reactive protein dropped to normal gradually. In the process of treatment, no obvious side effects were observed. Conclusion: Tocilizumab showed a significant clinical efficacy in the treatment of CRS,which greatly guaranteed the safety of the MM patients in the CAR-T treatment.

西安交通大学第二附属医院重大医疗技术资助项目(No. XJS201601)