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[嵌合抗原受体T细胞疗法治疗恶性淋巴瘤]

[CAR-T therapy for malignant lymphoma].

作者信息

Shimoyama Tatsu

机构信息

Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious.

出版信息

Rinsho Ketsueki. 2023;64(11):1447-1455. doi: 10.11406/rinketsu.64.1447.


DOI:10.11406/rinketsu.64.1447
PMID:38072433
Abstract

B-cell non-Hodgkin's lymphoma is a very heterogonous malignancy with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) as the most common subtypes. Recent advances in chimeric antigen receptor T-cell (CAR-T) therapy are changing the current landscape for management of relapsed or refractory (R/R) DLBCL and R/R FL, which have a poor prognosis. Pivotal trials leading to the FDA approval of three CD19 CAR-T cells (Yescarta, Kymriah and Breyanzi) showed complete response (CR) rates of 40-60%, with a significant subset of patients achieving long-term disease remission. Real-world studies have also confirmed this data. Notable toxicities include cytokine release syndrome and neurologic toxicities, which are usually treatable and reversible, as well as cytopenias and hypogammaglobulinemia. Salvage chemoimmunotherapy followed by high-dose chemotherapy and autologous stem cell rescue is the standard of care for chemo-sensitive and transplant-eligible R/R DLBCL. This review highlights the approved CAR-T constructs, including their efficacy, adverse effects, and real-world data.

摘要

B细胞非霍奇金淋巴瘤是一种非常异质性的恶性肿瘤,弥漫性大B细胞淋巴瘤(DLBCL)和滤泡性淋巴瘤(FL)是最常见的亚型。嵌合抗原受体T细胞(CAR-T)疗法的最新进展正在改变复发或难治性(R/R)DLBCL和R/R FL的当前治疗格局,这些患者预后较差。导致FDA批准三种CD19 CAR-T细胞(Yescarta、Kymriah和Breyanzi)的关键试验显示,完全缓解(CR)率为40-60%,有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一数据。显著的毒性包括细胞因子释放综合征和神经毒性,通常是可治疗和可逆的,以及血细胞减少和低丙种球蛋白血症。挽救性化疗免疫疗法,随后进行大剂量化疗和自体干细胞救援,是化疗敏感且适合移植的R/R DLBCL的标准治疗方法。本综述重点介绍了已获批的CAR-T构建体,包括它们的疗效、不良反应和真实世界数据。

相似文献

[1]
[CAR-T therapy for malignant lymphoma].

Rinsho Ketsueki. 2023

[2]
[Current and future perspectives on CAR-T cell therapy to adult malignant lymphoma].

Rinsho Ketsueki. 2023

[3]
CAR T cell therapy for B-cell lymphomas.

Best Pract Res Clin Haematol. 2018-6

[4]
Overcoming Barriers to Referral for Chimeric Antigen Receptor T Cell Therapy in Patients with Relapsed/Refractory Diffuse Large B Cell Lymphoma.

Transplant Cell Ther. 2023-7

[5]
Axicabtagene Ciloleucel, an Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy for Relapsed or Refractory Large B-Cell Lymphoma: Practical Implications for the Community Oncologist.

Oncologist. 2019-10-4

[6]
[CAR-T cells in lymphomas: Current and evolving role].

Bull Cancer. 2021-10

[7]
Relapsed or Refractory Diffuse Large B-Cell Lymphoma: "Dazed and Confused".

Oncology (Williston Park). 2022-6-10

[8]
Chimeric antigen receptor (CAR) T-cell therapy for people with relapsed or refractory diffuse large B-cell lymphoma.

Cochrane Database Syst Rev. 2021-9-13

[9]
Decitabine-primed tandem CD19/CD22 CAR-T therapy in relapsed/refractory diffuse large B-cell lymphoma patients.

Front Immunol. 2022

[10]
Axicabtagene ciloleucel CD19 CAR-T cell therapy results in high rates of systemic and neurologic remissions in ten patients with refractory large B cell lymphoma including two with HIV and viral hepatitis.

J Hematol Oncol. 2020-1-3

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