治疗失败模式在早期与晚期引入CAR T细胞疗法在大型B细胞淋巴瘤中
Magdalena Corona1, Andrew Ip2, Samantha Brown3
1Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Bone marrow transplantation
|February 1, 2025
概括
化学抗原受体T细胞 (CAR-T) 疗法对大B细胞淋巴瘤 (LBCL) 显示出类似的疾病控制,无论早期还是晚期的治疗. 在LBCL患者早期的CAR-T治疗有较少的毒性,但没有持续的生存优势.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
背景情况:
- CD19导向的仿制抗原受体T细胞 (CAR-T) 治疗已被批准用于复发/耐药的大B细胞淋巴瘤 (LBCL).
- 对CAR-T的最佳时间 (第二线与后一线) 仍然是一个研究领域.
研究的目的:
- 为了比较LBCL患者的疾病复发和进展模式,接受CAR-T作为第二线 (早期) 与第三线或随后的线 (晚期) 相比.
- 根据CAR-T治疗的时间来评估总生存率,无进展生存率和毒性概况.
主要方法:
- 对354名用Axicabtagene ciloleucel或Lisocabtagene maraleucel治疗的LBCL患者的回顾性分析.
- 早期 (n=80) 和晚期 (n=274) CAR-T 给药组之间的结果比较.
- 统计分析包括多变量考克斯回归和倾向得分匹配.
主要成果:
- 早期组的一年整体存活率最初更高 (82%对71%),但在调整后,这种益处没有持续.
- 一年后复发和无进展生存的累积发病率在早期和晚期给药组之间是相似的.
- 早期服用组的细胞因子释放综合征≥2级的发生率显著降低 (26%对39%) 和严重的中性质减退 (41%对55%).
结论:
- 卡特-T疗法在LBCL中表现出良好的结果,无论它是作为二线治疗还是后期治疗.
- 疾病控制等效表明,CAR-T耐药性的机制存在于一线治疗失败的LBCL中.
- 在LBCL中早期使用CAR-T可能会在不影响疾病控制的情况下提供毒性优势.
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