在大型B细胞淋巴瘤中,仿真抗原受体 (CAR) T细胞治疗失败后的结果
Anna Dodero1, Stefania Bramanti2, Martina Di Trani2
1Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
British journal of haematology
|September 10, 2023
概括
对于患有大型B细胞淋巴瘤的患者,在CAR T细胞治疗后复发后,救援疗法的结果很差. 在这些难以治疗的病例中,高循环瘤DNA水平表明预后更差.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
背景情况:
- 复发性/耐药性大B细胞淋巴瘤 (LBCL) 带来了重大治疗挑战.
- 化学抗原受体 (CAR) T细胞疗法 (axicabtagene ciloleucel, tisagenlecleucel) 是有效的,但并不普遍成功.
- 对于未能接受CAR T细胞治疗的患者来说,救援疗法选择有限,结果往往很差.
研究的目的:
- 评估LBCL患者的救援疗法的疗效和结果,这些患者在初始CAR T细胞治疗后进展.
- 为了确定影响这种患者群体生存的预后因素.
主要方法:
- 对51名LBCL患者的回顾性分析,这些患者未能接受CAR T细胞治疗.
- 患者接受了临床试验疗法 (glofitamab,loncastuximab,tesirine + ibrutinib) 或标准治疗 (lenalidomide,CPI,ibrutinib,化疗免疫疗法,放射治疗,支持性护理).
- 使用CAPP-seq在接受基于免疫治疗的救援治疗的患者小组中分析了循环瘤DNA (ctDNA).
主要成果:
- 总体而言,在11.7个月的中位随访期间,观察到35%的12个月整体存活率.
- 接受基于免疫治疗的救援治疗的患者 (n=26) 显示出不同的反应,在18名患者中使用双特异性抗体.
- 高ctDNA水平与糟糕的结果有关.
- 没有对先前的CAR T细胞疗法的反应以及除PMBCL和t-FL以外的其他诊断是显著的不良预后因素.
结论:
- 在LBCL中CAR T细胞衰竭后的救援疗法产生了不良结果.
- 在这种情况下,循环瘤DNA水平可能作为预后生物标志物.
- 进一步的研究至关重要,以开发更有效的治疗策略,以治疗复发性/耐药性LBCL患者的CAR后T细胞治疗.
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