Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy.
Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
Clin Lymphoma Myeloma Leuk. 2022 Feb;22(2):e135-e148. doi: 10.1016/j.clml.2021.09.005. Epub 2021 Sep 10.
immunotherapy (IT), including checkpoint inhibitors (CIs) and Chimeric Antigen Receptor T cell therapy (CAR-T) revolutionized the treatment of relapsing or refractory (r/r) lymphoma. Several preliminary experiences evaluated concomitant administration of radiotherapy and IT.
we performed a systematic review of current literature as of March 30, 2020. A total of 1090 records was retrieved, 42 articles were selected on the basis of title and abstract and, after the removal of analyses with no original data or insufficient clinical information, 28 papers were included in the review.
previous studies were mostly represented by case reports/series or small cohorts. Nonetheless, combination of radiotherapy and CIs or CAR-T led to promising outcomes, resulting in extremely high rates of complete response and improving progression free and overall survival compared with data from recent clinical trials. Combination of RT and CIs had a fair toxicity profile with no reports of severe side effects. Within the limits of the small cohorts retrieved, RT seems a superior option compared with systemic treatment as a 'bridge' to CAR-T and could as well reduce severe complications rates. Radiotherapy could elicit immune response against lymphoma, as demonstrated by multiple cases of abscopal effect and its inclusion in anti-neoplastic vaccines protocols.
The results of this review warrant the evaluation of combination of RT and immunotherapy in larger and preferably prospective and randomized cohorts to confirm these preliminary impressive outcomes. The optimal dose, fractionation and timing of RT still have to be clarified.
免疫疗法（IT），包括检查点抑制剂（CI）和嵌合抗原受体 T 细胞疗法（CAR-T），彻底改变了复发性或难治性（r/r）淋巴瘤的治疗方法。有几项初步经验评估了放疗与 IT 的联合应用。
我们对截至 2020 年 3 月 30 日的现有文献进行了系统评价。共检索到 1090 条记录，根据标题和摘要筛选出 42 篇文章，在去除没有原始数据或临床信息不足的分析后，共纳入 28 篇文章进行综述。
先前的研究主要由病例报告/系列或小队列组成。尽管如此，放疗与 CI 或 CAR-T 的联合应用带来了有前景的结果，与最近临床试验的数据相比，完全缓解率极高，并改善了无进展生存期和总生存期。RT 与 CI 的联合应用具有良好的毒性特征，没有严重副作用的报告。在检索到的小队列范围内，与全身治疗相比，RT 作为 CAR-T 的“桥梁”似乎是一种更好的选择，并且可以降低严重并发症的发生率。放疗可以引发针对淋巴瘤的免疫反应，这在多个肿瘤退缩效应的案例以及其被纳入抗肿瘤疫苗方案中得到了证实。
本综述的结果证明了在更大的、最好是前瞻性和随机队列中评估放疗与免疫疗法联合应用的价值，以确认这些初步令人印象深刻的结果。RT 的最佳剂量、分割和时机仍有待阐明。
