Neurooncology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Inserm, CNRS, UMR S 1127, ICM, IHU, Paris, France.
Clinical Hematology Department, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France.
Curr Oncol Rep. 2024 Nov;26(11):1521-1529. doi: 10.1007/s11912-024-01609-3. Epub 2024 Oct 28.
While anti-CD19 CAR T-cell therapy represents a major advance in systemic diffuse large B-cell lymphomas, central nervous system (CNS) lymphomas have been excluded from pivotal trials because of the fear of neurotoxicity. The purpose of this review was to assess the efficacy and tolerance of CAR T-cells in CNS lymphomas based on recently published studies.
All the studies on CAR T-cell therapy for both primary and secondary CNS lymphomas reported high response rates (complete response rates ranging from 32 to 67%) in highly pre-treated patients. One-year PFS reached 40 to 60% in several studies. Neurotoxicity occurred in 36 to 68% of patients, including grade 3-4 neurotoxicity in 4.5 to 29% of patients. CAR T-cell therapy appears to be a very promising treatment in CNS lymphomas, with efficacy results close to those observed in systemic lymphomas. The toxicity profile, notably regarding neurotoxicity, is reassuring and should not prevent the development of CAR T-cells in the disease.
尽管抗 CD19 CAR T 细胞疗法代表了全身性弥漫性大 B 细胞淋巴瘤治疗的重大进展，但中枢神经系统 (CNS) 淋巴瘤由于担心神经毒性而被排除在关键试验之外。本综述的目的是根据最近发表的研究评估 CAR T 细胞在 CNS 淋巴瘤中的疗效和耐受性。
所有关于原发性和继发性 CNS 淋巴瘤 CAR T 细胞治疗的研究均报道了在高度预处理的患者中具有高缓解率（完全缓解率范围为 32%至 67%）。在几项研究中，1 年无进展生存率达到了 40%至 60%。在 36%至 68%的患者中出现了神经毒性，包括 4.5%至 29%的患者出现 3-4 级神经毒性。CAR T 细胞疗法似乎是 CNS 淋巴瘤非常有前途的治疗方法，其疗效结果与全身性淋巴瘤相似。毒性谱，特别是神经毒性，令人放心，不应阻止该疾病中 CAR T 细胞的发展。
