Department of Bio-therapeutic, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China.
Department of Oncology, the first Medical Center, Chinese PLA General Hospital, 100853, Beijing, China.
Signal Transduct Target Ther. 2020 Jul 29;5(1):134. doi: 10.1038/s41392-020-00256-x.
Chimeric antigen receptor T (CAR T) cell therapy has demonstrated efficacy in the treatment of haematologic malignancies. However, the accompanying adverse events, the most common of which is cytokine release syndrome (CRS), substantially limit its wide application. Due to its unique physiological characteristics, CRS in CAR T-cell treatment for B-cell non-Hodgkin lymphoma (B-NHL) may exhibit some special features. Although existing guidelines had greatly promoted the recognition and management of CRS, many recommendations are not fully applicable to B-NHL. Therefore, it is imperative to identify responses that are specific to CRS observed following CAR T treatment for B-NHL. Based on underlying biological processes and known pathophysiological mechanisms, we tentatively propose a new model to illustrate the occurrence and evolution of CAR T-cell-therapy-related CRS in B-NHL. In this model, tumour burden and bone marrow suppression are considered determinants of CRS. Novel phenomena after CAR T-cell infusion (such as local inflammatory response) are further identified. The proposed model will help us better understand the basic biology of CRS and recognize and manage it more rationally.
嵌合抗原受体 T（CAR T）细胞疗法已被证明在治疗血液系统恶性肿瘤方面具有疗效。然而，伴随而来的不良反应，其中最常见的是细胞因子释放综合征（CRS），极大地限制了其广泛应用。由于其独特的生理特性，CAR T 细胞治疗 B 细胞非霍奇金淋巴瘤（B-NHL）时的 CRS 可能表现出一些特殊特征。尽管现有指南极大地促进了对 CRS 的认识和管理，但许多建议并不完全适用于 B-NHL。因此，确定 CAR T 治疗 B-NHL 后观察到的 CRS 特有的反应是当务之急。基于潜在的生物学过程和已知的病理生理机制，我们初步提出了一个新的模型来阐明 CAR T 细胞治疗相关 CRS 在 B-NHL 中的发生和演变。在该模型中，肿瘤负担和骨髓抑制被认为是 CRS 的决定因素。CAR T 细胞输注后出现的新现象（如局部炎症反应）也得到了进一步的确认。该模型将有助于我们更好地理解 CRS 的基础生物学，并更合理地识别和管理它。
