Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China.
Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China.
Cancer Lett. 2022 Nov 28;549:215721. doi: 10.1016/j.canlet.2022.215721. Epub 2022 May 7.
With the rapid revolution of therapies, hemopoietic stem cell transplantation (HSCT) has become a widely promoted treatment for hematological malignancies. High-dose chemotherapy (HDCT) followed by autologous blood cell (ABC) transplantation is a standard procedure for patients with primary relapse B-cell non-Hodgkin lymphoma (NHL) and multiple myeloma (MM), and allogeneic HSCT is one of the few treatments for patients with acute leukemia. However, refractory and recurrent disease has a negative impact on disease-free survival (DFS) for patients after HSCT. Furthermore, complications such as GVHD and infection significantly impair the quality of life and life expectancy of patients who receive allogeneic HSCT. The promising efficacy of chimeric antigen receptor T (CAR-T) cell therapy for relapsed or refractory B-cell acute lymphoblast leukemia (ALL) has offered hope for patients with R/R hematological malignancies. However, the long-term survival of patients after CAR-T cell therapy is also threatened by recurrent disease, and relapse occurs in half of patients who achieve remission. In addition, the rapid proliferation of CAR-T cells will cause damage to the balance of the immune system, leading to cytokine release syndrome (CRS) and CAR-T cell-related encephalopathy syndrome (CRES). Although therapeutic regimens such as IL-6 pathway blockers have obvious impacts on the side effects related to CAR-T cell therapy, there are still reports of patient deaths in past clinical trials. Based on the characteristics of HSCT and CAR-T cell therapy, it is unclear whether there is a better combination of cutting-edge immune cell therapy and traditional transplantation to improve the prognosis of patients. This review focuses on the possible ways to take full advantage of each therapy in the treatment of hematological malignancies.
随着治疗方法的快速发展，造血干细胞移植（HSCT）已成为治疗血液系统恶性肿瘤的广泛推广的方法。大剂量化疗（HDCT）继自体血细胞（ABC）移植是原发性复发性 B 细胞非霍奇金淋巴瘤（NHL）和多发性骨髓瘤（MM）患者的标准程序，异基因 HSCT是治疗急性白血病患者的少数方法之一。然而，难治性和复发性疾病对 HSCT 后患者的无病生存（DFS）产生负面影响。此外，移植物抗宿主病（GVHD）和感染等并发症严重影响接受异基因 HSCT 的患者的生活质量和预期寿命。嵌合抗原受体 T（CAR-T）细胞疗法对复发或难治性 B 细胞急性淋巴细胞白血病（ALL）的疗效显著，为 R/R 血液系统恶性肿瘤患者带来了希望。然而，CAR-T 细胞治疗后患者的长期生存也受到复发性疾病的威胁，缓解的患者中有一半会复发。此外，CAR-T 细胞的快速增殖会导致免疫系统平衡受损，导致细胞因子释放综合征（CRS）和 CAR-T 细胞相关脑病综合征（CRES）。尽管 IL-6 通路阻滞剂等治疗方案对与 CAR-T 细胞治疗相关的副作用有明显影响，但过去的临床试验仍有患者死亡的报道。基于 HSCT 和 CAR-T 细胞治疗的特点，尚不清楚是否有更好的方法将前沿免疫细胞疗法与传统移植相结合，以改善患者的预后。本综述重点讨论了充分利用每种疗法治疗血液系统恶性肿瘤的可能途径。
