Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Cancer Immunol Immunother. 2023 Jan;72(1):211-221. doi: 10.1007/s00262-022-03246-w. Epub 2022 Jul 7.
Chimeric antigen receptor (CAR) T cells are used to treat refractory and recurrent B-cell lymphoma. When administered intravenously, CAR T cells can be detected in cerebrospinal fluid, and thus represent a promising method for the treatment of central nervous system lymphoma (CNSL). This meta-analysis aimed to clarify the effectiveness and safety of CAR T-cell therapy in the treatment of CNSL.
Studies involving patients with CNSL who received CAR T-cell therapy that reported overall response (OR), complete response (CR), and partial response (PR) were included. A random-effects or fixed-effects model with double arcsine transformation was used for the pooled analysis and 95% confidence intervals (CI) were determined for all outcomes.
Eight studies, comprising 63 patients, were identified and were included in the meta-analysis. The pooled OR and CR rates after treatment with CAR T cells were 69% (95% CI, 56-81%) and 51% (95% CI, 37-64%), respectively. The pooled rate of progressive disease after remission was 38% (95% CI, 21-55%). The pooled rate for neurotoxicity grade 3 or above was 12% (95% CI, 3-24%, I = 0.00%, p = 0.53). No treatment-related deaths were reported.
CAR T-cell therapy is a promising option for the treatment of CNSL owing to a high short-term remission rate and controllable side effects. However, the high recurrence rate after remission must be addressed. Long-term follow-up data with large sample sizes are also needed to better assess the effectiveness and safety of CAR T-cell therapy.
This meta-analysis was registered in the international prospective register of systematic reviews (PROSPERO) (CRD42022301332).
嵌合抗原受体 (CAR) T 细胞被用于治疗难治性和复发性 B 细胞淋巴瘤。当静脉给药时，CAR T 细胞可在脑脊液中被检测到，因此代表了治疗中枢神经系统淋巴瘤 (CNSL) 的有前途的方法。本荟萃分析旨在阐明 CAR T 细胞疗法治疗 CNSL 的有效性和安全性。
纳入了报道总缓解 (OR)、完全缓解 (CR) 和部分缓解 (PR) 的接受 CAR T 细胞治疗的 CNSL 患者的研究。采用双反正弦变换的随机效应或固定效应模型进行汇总分析，并确定所有结局的 95%置信区间 (CI)。
确定了 8 项研究，共纳入 63 例患者，进行了荟萃分析。CAR T 细胞治疗后的 OR 和 CR 率分别为 69%（95%CI，56-81%）和 51%（95%CI，37-64%）。缓解后进展疾病的累积发生率为 38%（95%CI，21-55%）。神经毒性 3 级或以上的累积发生率为 12%（95%CI，3-24%，I=0.00%，p=0.53）。未报告与治疗相关的死亡。
由于短期缓解率高且副作用可控，CAR T 细胞疗法是治疗 CNSL 的一种有前途的选择。然而，缓解后复发率高的问题必须得到解决。还需要长期随访的大样本数据，以更好地评估 CAR T 细胞疗法的有效性和安全性。
本荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）（CRD42022301332）中进行了注册。
