移植患者癌症免疫疗法:风险与益处之间的难以平衡
Mónica Bolufer1,2, Jordi Soler1,2, María Molina1,2
1Department of Nephrology, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain.
概括
使用免疫检查点抑制剂 (ICPI) 的移植患者的癌症管理需要仔细的免疫抑制调整,以防止移植的排斥. 动态调整,而不是减少,是平衡抗癌疗法和移植存活的关键.
科学领域:
- 在瘤学瘤学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
背景情况:
- 癌症是移植患者疾病和死亡的重要原因.
- 免疫检查点抑制剂 (ICPI) 对癌症治疗具有前景,但存在移植排斥的风险 (在回顾性研究中高达40%).
研究的目的:
- 审查关于管理接受ICPI治疗的移植接受者 (KTR) 的最新证据.
- 探索癌症KTR患者的最佳免疫抑制策略.
- 告知科医生有关瘤性KTRs免疫抑制管理的新方法.
主要方法:
- 审查涉及KTR和ICPI的最近临床试验.
- 对病例系列,前性研究和病原学发现的分析.
- 对当前免疫抑制疗法和新兴生物标志物的评估.
主要成果:
- 最近的试验表明,从降低免疫抑制转向ICPI的KTR动态管理.
- 避免基底免疫抑制下降调整似乎至关重要.
- 新的生物标志物可能有助于个性化免疫抑制策略.
结论:
- 对于用ICPI治疗的KTRs来说,免疫抑制管理的范式转变是必要的.
- 建议采用动态免疫抑制策略,以平衡抗瘤疗效和移植保护.
- 进一步研究生物标志物和量身定制的治疗方案对于改善结果至关重要.
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