Al-Mansour Mubarak, Al-Foheidi Meteb, Ibrahim Ezzeldin
Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21451, Kingdom of Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 21423, Kingdom of Saudi Arabia.
Mol Clin Oncol. 2020 Oct;13(4):33. doi: 10.3892/mco.2020.2103. Epub 2020 Jul 29.
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma (NHL), representing 30% of all lymphoma cases. Within the first 2-3 years following immunochemotherapy, 30-40% of patients will experience a relapse or a refractory disease, thereby exhibiting a poor prognosis. High-dose immunotherapy followed by autologous stem cell transplantation is the standard care for relapsed/refractory (RR) patients with DLBCL. However, >60% of patients are ineligible for a transplant, presenting a therapeutic challenge. Chimeric antigen receptor (CAR) T-cell therapy has shown promising efficacy in patients with DLBCL, including those with R/R disease. The present study conducted a meta-analysis that showed highly favorable outcomes [objective response rate (ORR): 69%; complete remission (CR): 49%] in B-cell NHL patients (n=419) who were treated with second-generation CAR T cells. The response rate varied in different types of B-cell NHL. In 306 patients with R/R DLBCL eligible for rate evaluation, the ORR and CR rate mean estimates were 68% [95% confidence interval (CI), 55-79%] and 46% (95% CI, 38-54%), respectively. Thus, the findings indicated that immunotherapy with CAR T cells has improved outcomes for patients with R/R DLBCL and other subtypes of B-cell NHL compared with standard chemotherapy regimens. The study revealed that grade ≥3 anemia (34%) and thrombocytopenia (30%) were the most common adverse effects of CAR T-cell therapy. Incidence of grade ≥3 cytokine release syndrome and neurotoxicity associated with CAR T-cell therapy was effectively managed.
弥漫性大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤（NHL）最常见的亚型，占所有淋巴瘤病例的30%。在免疫化疗后的最初2 - 3年内，30% - 40%的患者会出现复发或难治性疾病，预后较差。大剂量免疫疗法联合自体干细胞移植是复发/难治性（RR）DLBCL患者的标准治疗方法。然而，超过60%的患者不符合移植条件，这带来了治疗挑战。嵌合抗原受体（CAR）T细胞疗法在DLBCL患者中显示出了有前景的疗效，包括那些复发/难治性（R/R）疾病患者。本研究进行了一项荟萃分析，结果显示接受第二代CAR T细胞治疗的B细胞NHL患者（n = 419）取得了非常好的疗效[客观缓解率（ORR）：69%；完全缓解（CR）：49%]。不同类型的B细胞NHL的缓解率有所不同。在306例符合缓解率评估条件的R/R DLBCL患者中，ORR和CR率的平均估计值分别为68%[95%置信区间（CI），55 - 79%]和46%（95%CI，38 - 54%）。因此，研究结果表明，与标准化疗方案相比，CAR T细胞免疫疗法改善了R/R DLBCL和其他B细胞NHL亚型患者的治疗效果。研究表明，≥3级贫血（34%）和血小板减少（30%）是CAR T细胞疗法最常见的不良反应。与CAR T细胞疗法相关的≥3级细胞因子释放综合征和神经毒性的发生率得到了有效控制。
