Westin Jason, Sehn Laurie H
Division of Cancer Medicine, Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX; and.
BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, BC, Canada.
Blood. 2022 May 5;139(18):2737-2746. doi: 10.1182/blood.2022015789.
The standard of care treatment strategy for patients with relapsed or refractory large B-cell lymphoma (LBCL) has been high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) if chemotherapy sensitive in suitable patients. Because of treatment intensity, this approach has only been feasible in half of patients and because of chemotherapy resistance has only been successful in a quarter of transplant-eligible patients. Chimeric antigen receptor (CAR) T-cell therapy, using genetically modified autologous T cells targeting CD19, has been approved for third-line therapy of LBCL and has been associated with durable remissions in a proportion of patients. In this review, we interpret the design and results of 3 randomized phase 3 trials comparing CAR T-cell therapy and ASCT and their implications for CAR T-cell therapy as a potential new standard of care for second-line treatment in appropriate patients with refractory or early relapsing LBCL.
对于复发或难治性大B细胞淋巴瘤（LBCL）患者，标准的治疗策略是大剂量化疗，若合适的患者对化疗敏感，则在化疗后进行自体干细胞移植（ASCT）。由于治疗强度较大，这种方法仅在一半的患者中可行，并且由于化疗耐药，仅在四分之一符合移植条件的患者中取得成功。嵌合抗原受体（CAR）T细胞疗法使用针对CD19的基因改造自体T细胞，已被批准用于LBCL的三线治疗，并且在一部分患者中实现了持久缓解。在本综述中，我们解读了3项比较CAR T细胞疗法和ASCT的随机3期试验的设计和结果，以及它们对于CAR T细胞疗法作为难治性或早期复发LBCL合适患者二线治疗潜在新标准的意义。
