成人B细胞急性淋巴细胞白血病从挽救性化疗转换为免疫治疗
Switching from salvage chemotherapy to immunotherapy in adult B-cell acute lymphoblastic leukemia.
作者信息
Kegyes David, Jitaru Ciprian, Ghiaur Gabriel, Ciurea Stefan, Hoelzer Dieter, Tomuleasa Ciprian, Gale Robert Peter
机构信息
Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania.
Department of Hematology-Medfuture Research Center for Advanced Medicine, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Romania; Department of Leukemia, Johns Hopkins Hospital, Baltimore, MD, USA.
出版信息
Blood Rev. 2023 May;59:101042. doi: 10.1016/j.blre.2023.101042. Epub 2023 Jan 20.
About one-half of adults with acute B-cell lymphoblastic leukemia (B-ALL) who do not achieve molecular complete remission or who subsequently relapse are not cured by current chemo- or targeted therapies. Previously, the sole therapeutic option for such persons was a hematopoietic stem cell transplant. Recently, several immune therapies including monoclonal antibodies, bispecific T-cell engagers (BiTEs), antibody-drug conjugates (ADCs), and chimeric antigen receptor T-cells (CARs) have been shown safe and effective in this setting. In this manuscript, we summarize data on US FDA-approved immune therapies of advanced adult B-ALL including rituximab, blinatumomab, inotuzumab ozogamicin, tisagenlecleucel and brexucabtagene autoleucel. We consider the results of clinical trials focusing on efficacy, safety, and quality of life (QoL). Real-world evidence is presented as well. We also briefly discuss pharmacodynamics, pharmacokinetics, and pharmacoeconomics followed by risk-benefit analyses. Lastly, we present future directions of immune therapies for advanced B-ALL in adults.
约一半未达到分子完全缓解或随后复发的急性B淋巴细胞白血病（B-ALL）成年患者无法通过目前的化疗或靶向治疗治愈。此前，这类患者唯一的治疗选择是造血干细胞移植。最近，包括单克隆抗体、双特异性T细胞衔接器（BiTEs）、抗体药物偶联物（ADCs）和嵌合抗原受体T细胞（CARs）在内的几种免疫疗法在这种情况下已被证明是安全有效的。在本手稿中，我们总结了美国食品药品监督管理局（FDA）批准的用于晚期成年B-ALL的免疫疗法的数据，包括利妥昔单抗、博纳吐单抗、伊尼妥单抗奥佐米星、替沙格韦生和布雷西尤单抗自体白细胞。我们考虑了聚焦于疗效、安全性和生活质量（QoL）的临床试验结果。也展示了真实世界证据。我们还简要讨论了药效学、药代动力学和药物经济学，随后进行了风险效益分析。最后，我们介绍了成年晚期B-ALL免疫疗法的未来方向。
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