Mihaila Romeo Gabriel, Todor Samuel B
Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550024 Sibiu, Romania.
J Clin Med. 2025 Aug 6;14(15):5534. doi: 10.3390/jcm14155534.
T-cell-engaging antibodies are a promising new type of treatment for patients with refractory or relapsed (R/R) diffuse large B-cell lymphoma, which has changed the prognosis and evolution of these patients in clinical trials. Bispecific antibodies (BsAbs) bind to two different targets (B and T lymphocytes) at the same time and in this way mimic the action of CAR (chimeric antigen receptor) T-cells. They are the T-cell-engaging antibodies most used in practice and are a solution for patients who do not respond to second- or later-line therapies, including chemoimmunotherapy, followed by salvage chemotherapy and hematopoietic stem cell transplantation. They are a therapeutic option for patients who are ineligible for CAR T-cell therapy and are also active in those with prior exposure to CAR T-cell treatment. A remarkable advantage of BsAbs is their rapid availability, even if the disease progresses rapidly, unlike CAR T-cell treatment, and they avoid the practical and financial challenges raised by autologous CAR T-cell therapies. CAR-T has been proven to have better efficacy compared to BsAbs, but cytokine release syndrome and neurotoxicity have appeared significantly more frequently in patients treated with CAR T-cells. The possibility of combining BsAbs with chemotherapy and their administration for relapses or as a frontline therapy is being studied to increase their efficacy. BsAbs are a life-saving therapy for many patients with diffuse large B-cell malignant non-Hodgkin's lymphoma (NHL) who have a poor prognosis with classical therapies, but are not without adverse effects and require careful monitoring.
T细胞接合抗体是难治性或复发性(R/R)弥漫性大B细胞淋巴瘤患者一种很有前景的新型治疗方法,在临床试验中改变了这些患者的预后和病程。双特异性抗体(BsAbs)同时结合两个不同靶点(B淋巴细胞和T淋巴细胞),从而模拟嵌合抗原受体(CAR)T细胞的作用。它们是实际应用中最常用的T细胞接合抗体,为对二线或后续治疗(包括化疗免疫治疗)无反应的患者提供了一种解决方案,这些患者后续还需接受挽救性化疗和造血干细胞移植。对于不符合CAR T细胞治疗条件的患者,BsAbs是一种治疗选择,对于既往接受过CAR T细胞治疗的患者也有活性。BsAbs的一个显著优势是即使疾病进展迅速,它们也能快速获得,这与CAR T细胞治疗不同,而且它们避免了自体CAR T细胞疗法带来的实际和经济挑战。与BsAbs相比,CAR-T已被证明具有更好的疗效,但接受CAR T细胞治疗的患者中,细胞因子释放综合征和神经毒性的出现频率明显更高。目前正在研究将BsAbs与化疗联合使用以及将其用于复发或作为一线治疗的可能性,以提高其疗效。对于许多采用传统疗法预后较差的弥漫性大B细胞恶性非霍奇金淋巴瘤(NHL)患者来说,BsAbs是一种挽救生命的疗法,但并非没有不良反应,需要仔细监测。
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