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超越最大分级:血液系统恶性肿瘤中免疫疗法、细胞疗法和靶向药物的耐受性

Beyond maximum grade: tolerability of immunotherapies, cellular therapies, and targeted agents in haematological malignancies.

作者信息

Bröckelmann Paul J, Cliff Edward R Scheffer, Iacoboni Gloria, Simon Florian, Horowitz Mary M, Keating Armand, Mateos Maria-Victoria, Mohty Mohamad, Sidana Surbhi, Song Yuqin, Wingard John R, Thanarajasingam Gita

机构信息

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany; German Hodgkin Study Group, Cologne, Germany; Max Planck Institute for Biology of Ageing, Cologne, Germany.

Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.

出版信息

Lancet Haematol. 2025 Jun;12(6):e470-e481. doi: 10.1016/S2352-3026(25)00051-1.

Abstract

The increasing use of immunotherapeutic approaches, cellular therapies, and targeted agents is rapidly and profoundly changing the treatment paradigms of haematological malignancies. These novel therapies are increasingly incorporated into earlier lines of treatment. Some are administered for a fixed duration, often with curative intent, whereas others are administered chronically for disease control. The associated acute, mid-term, and long-term toxic effects can differ markedly from conventional cytotoxic chemotherapy and radiotherapy. Accumulating clinical experience and data enable identification of class-specific effects and development of consensus-based guidelines for toxicity management. In this third paper in the Series on adverse event reporting, we build on our emerging understanding of toxicity profiles of novel treatments to propose an actionable framework for improved assessment, reporting, and critical appraisal of treatment tolerability. We discuss recent insights regarding second cancers and the relevance of infectious complications, explore tolerability aspects of time-limited treatments, and suggest approaches to address gaps in tolerability assessment.

摘要

免疫治疗方法、细胞疗法和靶向药物的使用日益增加,正在迅速且深刻地改变血液系统恶性肿瘤的治疗模式。这些新型疗法越来越多地被纳入早期治疗方案。有些疗法会在固定疗程内给药,通常旨在治愈疾病,而其他疗法则是长期给药以控制疾病。其相关的急性、中期和长期毒性作用可能与传统的细胞毒性化疗和放疗有显著差异。不断积累的临床经验和数据有助于识别各类特异性效应,并制定基于共识的毒性管理指南。在本系列关于不良事件报告的第三篇论文中,我们基于对新型治疗毒性特征的新认识,提出一个可行的框架,以改进对治疗耐受性的评估、报告和批判性评价。我们讨论了关于第二原发癌的最新见解以及感染性并发症的相关性,探讨了限时治疗的耐受性方面,并提出解决耐受性评估差距的方法。

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