[Observation of liver indexes in patients with relapsed/refractory multiple myeloma treated with CAR-T-cells based on BCMA]

Objective: To observe the characteristics of the evolution of liver indexes in patients with relapsed/refractory multiple myeloma (RRMM) treated with CAR-T-cells based on BCMA. Methods: Retrospective analysis was performed of patients with RRMM who received an infusion of anti-BCMA CAR-T-cells and anti-BCMA combined with anti-CD19 CAR-T-cells at our center between June 1, 2019, and February 28, 2023. Clinical data were collected to observe the characteristics of changes in liver indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL) in patients, and its relationship with cytokine-release syndrome (CRS) . Results: Ninety-two patients were included in the analysis, including 41 patients (44.6%) in the group receiving a single infusion of anti-BCMA CAR-T-cells, and 51 patients (55.4%) in the group receiving an infusion of anti-BCMA combined with anti-CD19 CAR-T-cells. After infusing CAR-T-cells, 31 patients (33.7%) experienced changes in liver indexes at or above grade 2, which included 20 patients (21.7%) with changes in one index, five patients (5.4%) with changes in two indexes, and six patients (6.5%) with changes in three or more indexes. The median time of peak values of ALT and AST were d17 and d14, respectively, and the median duration of exceeding grade 2 was 5.0 and 3.5 days, respectively. The median time of peak values of TBIL and DBIL was on d19 and d21, respectively, and the median duration of exceeding grade 2 was 4.0 days, respectively. The median time of onset of CRS was d8, and the peak time of fever was d9. The ALT, AST, and TBIL of patients with CRS were higher than those of patients without CRS (P=0.011, 0.002, and 0.015, respectively). CRS is an independent factor that affects ALT and TBIL levels (OR=19.668, 95% CI 18.959-20.173, P=0.001). The evolution of liver indexes can be reversed through anti-CRS and liver-protection treatments, and no patient died of liver injury. Conclusions: In BCMA-based CAR-T-cell therapy for RRMM, CRS is an important factor causing the evolution of liver indexes. The evolution of liver indexes after CAR-T-cell infusion is transient and reversible after treatment.

Optimizing nitrogen fertilizer amount for best performance and highest economic return of winter wheat under limited irrigation conditions

Inappropriate water and fertilizer management can lead to unstable crop yields. Excessive fertilization can potentially cause soil degradation and nitrogen (N) leaching. The aim of this study was to explore the optimal N application rate on two wheat varieties with different nitrogen responding under limited water irrigation at three experimental sites in the Piedmont plain of the Taihang Mountains, China. A two-year field experiment was conducted to explore the effects of five N application rates (N0, N120, N180, N240, and N300) on winter wheat growth, leaf area index, aboveground biomass, grain yield, grain N accumulation, and net return. The results showed that N application rate significantly affected leaf area index, aboveground biomass, grain yield, and harvest index. Variety and variety × N rate interactions had a significant effect on few indicators. Compared with N0, N180 improved leaf area index, aboveground biomass, grain yield, and grain N accumulation. Compared with N240 and N300, N180 increased the harvest index and N harvest index, without significantly reducing grain yield or grain N accumulation, while enhancing a higher N use efficiency. Fertilizers applied in the ranges of 144.7-212.9 and 150.3-247.0 kg ha-1 resulted in the highest net return for the KN199 and JM585 varieties, respectively. Our study provides a sound theoretical basis for high-efficiency fertilizer utilization in sustainable winter wheat production in the Piedmont plains of the Taihang Mountains of China.