Alteration and significance of serum lipid levels and nutritional status during BCMA-CAR-T-cell therapy in patients with refractory or relapsed multiple myeloma: a retrospective study based on LEGEND-2 / 中华血液学杂志

Objective: To explore the dynamic changes in serum lipid levels and nutritional status during BCMA-CAR-T-cell therapy in patients with refractory or relapsed multiple myeloma (R/R MM) based on LEGEND-2. Methods: The data of patients with R/R MM who underwent BCMA-CAR-T therapy at our hospital between March 30, 2016, and February 6, 2018, were retrospectively collected. Serum lipid levels, controlled nutritional status (CONUT) score, and other clinical indicators at different time points before and after CAR-T-cell infusion were compared and analyzed. The best cut-off value was determined by using the receiver operator characteristic (ROC) curve. The patients were divided into high-CONUT score (>6.5 points, malnutrition group) and low-CONUT score groups (≤6.5 points, good nutrition group), comparing the progression-free survival (PFS) and total survival (OS) of the two groups using Kaplan-Meier survival analysis. Results: Before the infusion of CAR-T-cells, excluding triglycerides (TG), patients' serum lipid levels were lower than normal on average. At 8-14 d after CAR-T-cell infusion, serum albumin (ALB), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and apolipoprotein A1 (Apo A1) levels dropped to the minimum, whereas CONUT scores reached the maximum. In addition to TG, apolipoprotein B (Apo B) levels increased compared with baseline. After CAR-T-cell therapy, the patients' serum lipid levels significantly increased with well-improved nutritional status. Spearman's related analysis showed that TC, HDL, and ApoA1 levels after CAR-T-cell injection were significantly negatively correlated with the grade of cytokine-release syndrome (CRS) (r=-0.548, P=0.003; r=-0.444, P=0.020; r=-0.589, P=0.001). Furthermore, survival analysis indicated that the CONUT score was unrelated to PFS, and the median OS of patients with R/R MM in the high-CONUT score group was shorter than that in the low-CONUT score group (P=0.046) . Conclusions: During CAR-T-cell therapy, hypolipidemia and poor nutritional status were aggravated, which is possibly related to CRS. The patients' serum lipid levels and nutritional status were significantly improved after CAR-T-cell treatment. The CONUT score affected the median OS in patients treated with CAR-T-cells. Therefore, specific screening and intervention for nutritional status in patients receiving CAR-T-cell therapy are required.

Effects of Thrombolysis on Short- and Long-term Outcome in Patients with Cerebral Infarction / 中国康复理论与实践

@#Objective To study the effects of thrombolysis on short- and long-term outcome in acute cerebral infarction patients. Methods The patients accepted thrombolysis and remained severe neurologic deficits were as observation group (n=29), and the patients without thrombolysis matching the onset time and severity of disease were as control group (n=94). They were assessed with National Institute of Health Stroke Scale (NIHSS), Manual Muscle Test (MMT), Brunnstrom Grade, modified Barthel Index (MBI) when they admitted and discharged, and with modified Rankin Scale (mRS) 6 months later. Results The scores of MMT, MBI and Brunnstrom grade improved in both groups when discharged (P<0.05), except the NIHSS in the control group, and the scores of NIHSS and MBI improved more in the observation group than in the control group (P<0.05). The score of mRS was better in the observation group than in the control group 6 months later (P<0.05). Conclusion Thrombolysis can improve the neurologic function and activities of daily living in the acute stage of cerebral infarction, as well as the long-term outcome of activities.