a Department of Pediatric Hematology and Oncology, Cellular and Gene Therapy , IRCCS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
b Department of Pediatrics , Sapienza University of Rome , Rome , Italy.
Expert Rev Clin Immunol. 2019 May;15(5):497-509. doi: 10.1080/1744666X.2019.1573672. Epub 2019 Feb 6.
The last few years have witnessed what can certainly be defined as a 'period of renaissance' for immunotherapy in the field of hematological malignancies. In particular, antibody-mediated and cell-mediated immunotherapy have significantly changed the treatment approach of patients with B-cell lymphoproliferative disorders. These therapies, initially employed in patients with refractory/relapsed disease, are now integrated in the treatment of newly diagnosed patients. Together with the therapeutic success, we have also learnt that these innovative therapies can induce relevant, sometimes life-threatening or even fatal, side effects. Areas covered: In this review article, we analyzed the applicative therapeutic scenario and the peculiar toxicities associated with approaches of immunotherapy, paying particular attention to the new emerging side effects, substantially unknown before the introduction of these therapies. Expert commentary: Both monoclonal antibodies and cell therapy with lymphocytes genetically modified to be redirected against leukemia targets through the transduction with chimeric antigen receptors (CARs) have obtained unprecedented success in rescuing patients with resistant B-cell malignancies. Complications, such as neurotoxicity, cytokine release syndrome or persistent B-cell lymphopenia, must always be taken into consideration and diagnosed in a timely manner in patients with B-cell neoplasms to guarantee optimal management, thus avoiding they blunting the efficacy of immunotherapy.
过去几年见证了免疫疗法在血液恶性肿瘤领域的“复兴时期”。特别是，抗体介导和细胞介导的免疫疗法显著改变了 B 细胞淋巴瘤患者的治疗方法。这些疗法最初用于难治性/复发性疾病患者，现在已整合到新诊断患者的治疗中。随着治疗的成功，我们也了解到这些创新疗法可能会引起相关的、有时危及生命甚至致命的副作用。涵盖领域：在这篇综述文章中，我们分析了免疫疗法的应用治疗方案和相关毒性，特别关注新出现的、在这些疗法引入之前基本不为人知的副作用。专家评论：单克隆抗体和细胞疗法都取得了前所未有的成功，通过转导嵌合抗原受体（CAR），使淋巴细胞重新定向针对白血病靶点，从而挽救了耐药 B 细胞恶性肿瘤患者。对于 B 细胞肿瘤患者，必须始终考虑并及时诊断神经毒性、细胞因子释放综合征或持续的 B 细胞淋巴细胞减少症等并发症，以保证最佳管理，从而避免免疫疗法的疗效减弱。
