在B细胞淋巴瘤中使用CAR T细胞治疗后复发的治疗策略
Shuto Negishi1, James H Girsch2,3,4,5, Elizabeth L Siegler2,3
1Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan.
Frontiers in pediatrics
|January 29, 2024
概括
化学抗原受体T (CART19) 细胞疗法对B细胞恶性瘤有希望,但复发发生. 本综述探讨了在CART19治疗后复发的患者的救援疗法.
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:
- 抗CD19仿真抗原受体T (CART19) 细胞疗法为复发性/耐药性B细胞恶性瘤提供高响应率.
- 尽管获得FDA批准,但持久缓解仍然是一个挑战,30%-60%的患者在CART19输注后复发.
- 复发后CART19治疗与预后不佳有关,需要对有效的救援策略进行调查.
研究的目的:
- 审查和讨论CART19细胞治疗后复发/耐药的大B细胞淋巴瘤患者目前的救援疗法.
- 根据CD19表达 (阳性与负性复发) 来分类CART19失败.
- 探索对CD19阳性复发 (例如,再输注,免疫检查点抑制剂) 和CD19阴性复发 (例如,替代CAR T细胞点,化疗,干细胞移植) 的治疗选择.
主要方法:
- 在CART19治疗后,对大型B细胞淋巴瘤报告的救援疗法的文献综述.
- 基于复发性淋巴瘤细胞的CD19表达状态的治疗策略分析.
- 讨论在这个患者群体中进行救援治疗的临床决策.
主要成果:
- CART19失败的特征是CD19阳性或CD19阴性淋巴瘤复发.
- 对于CD19阳性复发,选择包括重复CART19输注或免疫检查点抑制剂的重新激活.
- 对于CD19阴性复发,可以考虑使用其他CAR T细胞点 (CD20,CD22),化疗或干细胞移植.
结论:
- 在CART19后复发的大型B细胞淋巴瘤的救援疗法是复杂的,通常是个别情况下进行的.
- 了解复发的机制 (CD19阳性与阴性) 对于选择适当的救援治疗至关重要.
- 需要进一步的研究和标准化的方法来优化CART19治疗后复发的患者的结果.
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