Amhaz Ghid, Bazarbachi Ali, El-Cheikh Jean
Division of hematology-oncology, American University of Beirut Medical Center, Beirut, Lebanon.
Leuk Res Rep. 2022 May 18;17:100325. doi: 10.1016/j.lrr.2022.100325. eCollection 2022.
Treatment of non-Hodgkin lymphoma (NHL) in general has improved over the years with the emergence of the monoclonal antibodies (MAB) therapy. NHL is divided into B cell NHL and T cell NHL. Treatment of NHL was based on the subtype of NHL and its staging. NHL is divided into aggressive and indolent NHL (iNHL). Subtypes of iNHL include: Follicular lymphoma (FL), Marginal zone lymphoma (MZL), Chronic lymphocytic leukemia/small-cell lymphocytic lymphoma (CLL/SLL), Gastric mucosa-associated lymphoid tissue (MALT) lymphoma, Lymphoplasmacytic lymphoma, Waldenström macroglobulinemia, Nodal marginal zone lymphoma (NMZL), Splenic marginal zone lymphoma (SMZL). Chemotherapy was the main stay treatment of iNHL until the emergence of Rituximab, anti-CD20 MAB targeting CD-20 surface cell antigens that are present on B-cells lymphoma and not on precursor cells, mainly efficacious in B cell iNHL, It became the mainstay treatment in follicular lymphoma (FL) as a single agent modality or in combination with chemotherapy. The anti-CD20 Rituximab played an important role in the development of the treatment of iNHL to become FDA approved in 1997. It was also proven effective in multiple other types of lymphoma. MAB through targeting the cell surface antigen leads to a direct or immune mediated cytotoxicity. This carries few side effects, including allergic reactions. Other than that, a resistance mechanism to rituximab emerged by inducing a failure in the apoptosis mechanism. Alternative mechanisms of resistance included the presence of soluble antigens that could act by binding to the antibody present before the drug itself can bind the lymphoma cell. Thus, the interest in immunotherapy grew further to explore the possibility of conjugating an immune mediated drug to a radio-sensitizing agent in order to enhance the selectivity of the drug. Here came the development of 90Y-ibritumomab tiuxetan and 131I-tositumomab. After it, humanized anti-CD20 emerged ofatumumab, IMMU106 (veltuzumab) in 2005, and ocrelizumab which are considered as second generation anti-CD20 and 3 generation anti-CD20 include AME-133v (ocaratuzumab), PRO131921 and GA101 (obinutuzumab). Also multiple other agents emerged targeting different surface cell antigens like CD52 (alemtuzumab), CD22 (unconjugated epratuzumab and calicheamicin conjugated CMC-544 [inotuzumab ozogamicin]), CD80 (galiximab), CD2 (MEDI-507 [siplizumab]), CD30 (SGN-30 and MDX-060 [iratumumab], Brentuximab vedotin), CD40 (SGN-40), and CD79b (Polatuzumab). Other agents include MAB targeting T-Cells like mogamulizumab, Denileukin Diftitox and BiTEs or bispecific T cell engagers like Mosunetuzumab, Glofitamab, and Epcoritamab. Moreover, further studies came up to evaluate the role of immunotherapy in combination chemotherapy as a pathway to evade the resistance mechanisms. Side effects of the treatment were mainly infusion related adverse reactions, myelosuppression in conjugated forms leading to immunosuppression and subsequently to infectious complications. Another important aspect in immunotherapy is the half-lives of the medication which is an important factor that can influence the evaluation of the response. The MAB treatment showed important benefit in the treatment of iNHL and it continuously shows how rapidly it can develop to provide optimum care and benefit to patients with iNHL.
多年来,随着单克隆抗体(MAB)疗法的出现,非霍奇金淋巴瘤(NHL)的总体治疗情况有所改善。NHL分为B细胞NHL和T细胞NHL。NHL的治疗基于其亚型及其分期。NHL分为侵袭性和惰性NHL(iNHL)。iNHL的亚型包括:滤泡性淋巴瘤(FL)、边缘区淋巴瘤(MZL)、慢性淋巴细胞白血病/小细胞淋巴细胞淋巴瘤(CLL/SLL)、胃黏膜相关淋巴组织(MALT)淋巴瘤、淋巴浆细胞淋巴瘤、华氏巨球蛋白血症、结内边缘区淋巴瘤(NMZL)、脾边缘区淋巴瘤(SMZL)。在利妥昔单抗出现之前,化疗一直是iNHL的主要治疗方法,利妥昔单抗是一种抗CD20单克隆抗体,靶向B细胞淋巴瘤表面存在而前体细胞上不存在的CD-20表面细胞抗原,主要对B细胞iNHL有效,它成为滤泡性淋巴瘤(FL)的主要治疗方法,可作为单一药物使用或与化疗联合使用。抗CD20利妥昔单抗在iNHL治疗的发展中发挥了重要作用,并于1997年获得美国食品药品监督管理局(FDA)批准。它在多种其他类型的淋巴瘤中也被证明有效。单克隆抗体通过靶向细胞表面抗原导致直接或免疫介导的细胞毒性。这带来的副作用很少,包括过敏反应。除此之外,通过诱导凋亡机制失败出现了对利妥昔单抗的耐药机制。其他耐药机制包括存在可溶性抗原,这些抗原可通过在药物本身能够结合淋巴瘤细胞之前与存在的抗体结合而起作用。因此,对免疫疗法的兴趣进一步增加,以探索将免疫介导药物与放射增敏剂偶联以提高药物选择性的可能性。于是出现了90Y-伊布替膦酸钇和131I-托西莫单抗。在此之后,出现了人源化抗CD20的奥法木单抗、2005年的IMMU106(维妥珠单抗)和奥瑞珠单抗,它们被认为是第二代抗CD20药物,第三代抗CD20药物包括AME-133v(奥卡妥珠单抗)、PRO131921和GA101(奥妥珠单抗)。此外,还出现了多种靶向不同表面细胞抗原的其他药物,如CD52(阿仑单抗)、CD22(未偶联的依帕珠单抗和与卡奇霉素偶联的CMC-544[英妥昔单抗])、CD80(加利昔单抗)、CD2(MEDI-507[西普利单抗])、CD30(SGN-30和MDX-060[伊鲁单抗]、维布妥昔单抗)、CD40(SGN-40)和CD79b(泊洛妥珠单抗)。其他药物包括靶向T细胞的单克隆抗体,如莫加莫单抗、地尼白介素-妥西莫单抗和双特异性T细胞衔接器,如莫斯奈妥单抗、格菲妥单抗和艾可瑞妥单抗。此外,还进行了进一步的研究,以评估免疫疗法联合化疗在规避耐药机制方面的作用。治疗的副作用主要是与输注相关的不良反应,偶联形式的骨髓抑制会导致免疫抑制,进而引发感染并发症。免疫疗法的另一个重要方面是药物的半衰期,这是一个可以影响疗效评估的重要因素。单克隆抗体治疗在iNHL的治疗中显示出重要益处,并且不断展示出其发展速度之快,能够为iNHL患者提供最佳护理和益处。