嵌合抗原受体 T 细胞疗法与自体造血干细胞移植治疗复发或难治性弥漫大 B 细胞淋巴瘤的疗效：一项系统评价。
Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review.
机构信息
Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Clinical Testing Center, Chinese Academy of Medical Sciences Blood Disease Hospital, Chinese Academy of Medical Sciences Institute of Hematology, State Key Laboratory of Experimental Hematology, National Clinical Medical Center for Blood Disease, Tianjin, China.
出版信息
Front Immunol. 2023 Jan 17;13:1041177. doi: 10.3389/fimmu.2022.1041177. eCollection 2022.
BACKGROUND
We aimed to compare the efficacy of chimeric antigen receptor T (CAR-T) cell therapy with that of autologous stem cell transplantation (auto-HSCT) in relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL).
RESEARCH DESIGN AND METHODS
We searched eligible publications up to January 31st, 2022, in PubMed, Cochrane Library, Springer, and Scopus. A total of 16 publications with 3484 patients were independently evaluated and analyzed using STATA SE software.
RESULTS
Patients who underwent CAR-T cell therapy showed a better overall response rate (ORR) and partial response (PR) than those treated with auto-HSCT (CAR-T vs. auto-HSCT, ORR: 80% vs. 73%, HR:0.90,95%CI:0.76-1.07, = 0.001; PR: 20% vs. 14%, HR:0.65,95%CI:0.62-0.68, = 0.034). No significant difference was observed in 6-month overall survival (OS) (CAR-T vs. auto-HSCT, six-month OS: 81% vs. 84%, HR:1.23,95%CI:0.63-2.38, = 0.299), while auto-HSCT showed a favorable 1 and 2-year OS (CAR-T vs. auto-HSCT, one-year OS: 64% vs. 73%, HR:2.42,95%CI:2.27-2.79, P < 0.001; two-year OS: 54% vs. 68%, HR:1.81,95%CI:1.78-1.97, P < 0.001). Auto-HSCT also had advantages in progression-free survival (PFS) (CAR-T vs. auto-HSCT, six-month PFS: 53% vs. 76%, HR:2.81,95%CI:2.53-3.11, < 0.001; one-year PFS: 46% vs. 61%, HR:1.84,95%CI:1.72-1.97, < 0.001; two-year PFS: 42% vs. 54%, HR:1.62,95%CI:1.53-1.71, < 0.001). Subgroup analysis by age, prior lines of therapy, and ECOG scores was performed to compare the efficacy of both treatment modalities.
CONCLUSION
Although CAR-T cell therapy showed a beneficial ORR, auto-HSCT exhibited a better long-term treatment superiority in R/R DLBCL patients. Survival outcomes were consistent across different subgroups.
背景
我们旨在比较嵌合抗原受体 T (CAR-T) 细胞疗法与自体造血干细胞移植 (auto-HSCT) 在复发/难治性弥漫性大 B 细胞淋巴瘤 (R/R DLBCL) 患者中的疗效。
研究设计与方法
我们在 PubMed、Cochrane Library、Springer 和 Scopus 上检索了截至 2022 年 1 月 31 日的合格文献。使用 STATA SE 软件独立评估和分析了 16 项包含 3484 名患者的研究。
结果
与接受 auto-HSCT 治疗的患者相比，接受 CAR-T 细胞治疗的患者的总体缓解率 (ORR) 和部分缓解 (PR) 更好（CAR-T 与 auto-HSCT，ORR：80% vs. 73%，HR：0.90，95%CI：0.76-1.07，=0.001；PR：20% vs. 14%，HR：0.65，95%CI：0.62-0.68，=0.034）。6 个月总生存率（OS）无显著差异（CAR-T 与 auto-HSCT，6 个月 OS：81% vs. 84%，HR：1.23，95%CI：0.63-2.38，=0.299），而 auto-HSCT 的 1 年和 2 年 OS 更具优势（CAR-T 与 auto-HSCT，1 年 OS：64% vs. 73%，HR：2.42，95%CI：2.27-2.79，P < 0.001；2 年 OS：54% vs. 68%，HR：1.81，95%CI：1.78-1.97，P < 0.001）。Auto-HSCT 在无进展生存率（PFS）方面也具有优势（CAR-T 与 auto-HSCT，6 个月 PFS：53% vs. 76%，HR：2.81，95%CI：2.53-3.11，< 0.001；1 年 PFS：46% vs. 61%，HR：1.84，95%CI：1.72-1.97，< 0.001；2 年 PFS：42% vs. 54%，HR：1.62，95%CI：1.53-1.71，< 0.001）。我们进行了年龄、先前治疗线数和 ECOG 评分的亚组分析，以比较两种治疗方式的疗效。
结论
尽管 CAR-T 细胞疗法显示出有益的 ORR，但在 R/R DLBCL 患者中，auto-HSCT 表现出更好的长期治疗优势。生存结果在不同亚组中是一致的。
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