Shimoyama Tatsu
Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious.
Rinsho Ketsueki. 2023;64(9):1192-1202. doi: 10.11406/rinketsu.64.1192.
Recent advances with chimeric antigen receptor T-cell (CAR-T) therapy are changing the current landscape of poor-prognosis relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Pivotal trials leading to the FDA approval of three CD19 CAR-T cells, namely, Yescarta, Kymriah, and Breyanzi, demonstrated complete response rates of 40-60%, with a significant subset of patients achieving long-term disease remission, and real-world studies confirm these data. In Japan, CAR-T therapy was approved for R/R DLBCL in 2019 and for R/R follicular lymphoma in 2022. However, guidelines are not clear on which CAR-T agents should be indicated for which patients and at which timing, and currently, institutions decide and operate according to their criteria. To optimize CAR-T therapy under the best conditions, the treatment strategy must be decided with the referring institution in terms of T-cell fitness and tumor volume. Therefore, institutional collaboration to monitor long-term adverse events after CAR-T therapy is important.
嵌合抗原受体T细胞（CAR-T）疗法的最新进展正在改变预后不良的复发/难治性弥漫性大B细胞淋巴瘤（R/R DLBCL）的当前格局。三项CD19 CAR-T细胞（即Yescarta、Kymriah和Breyanzi）获得美国食品药品监督管理局（FDA）批准的关键试验显示，完全缓解率为40%-60%，相当一部分患者实现了长期疾病缓解，真实世界研究也证实了这些数据。在日本，CAR-T疗法于2019年被批准用于R/R DLBCL，2022年被批准用于R/R滤泡性淋巴瘤。然而，关于哪些患者应在何时使用哪种CAR-T药物，指南并不明确，目前各机构根据自身标准进行决策和操作。为了在最佳条件下优化CAR-T疗法，必须根据T细胞健康状况和肿瘤体积与转诊机构共同决定治疗策略。因此，机构间合作监测CAR-T治疗后的长期不良事件很重要。
