肿瘤细胞治疗研究
英文原题：How I treat refractory/relapsed diffuse large B-cell lymphomas with CD19-directed chimeric antigen receptor T cells.
How I treat refractory/relapsed diffuse large B-cell lymphomas with CD19-directed chimeric antigen receptor T cells.
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靶向CD19的嵌合抗原受体（CAR）T细胞是复发/难治性弥漫大B细胞淋巴瘤（R/R DLBCL）有前景的挽救免疫疗法，长期缓解率约40%。在日常临床实践中，参与R/R DLBCL患者CAR-T 治疗的血液科医生必须处理诊断复杂的病例并作出困难治疗选择。R/R DLBCL新型免疫治疗药物的出现，以及对CAR-T 失败机制认识的近期进展，要求采用合理方法选择最佳桥接治疗并管理CAR-T 治疗后复发。此外，正电子发射断层扫描/计算机断层扫描（PET/CT）可能出现假阳性判读，凸显治疗后活检的重要性。本综述讨论上述问题并介绍4例具有启发性的病例，旨在为DLBCL CAR-T 治疗提供判断标准和新视角。
Chimeric antigen receptor (CAR) T cells targeting CD19 represent a promising salvage immunotherapy for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), offering ~40% of long-term responses. In everyday clinical practice, haematologists involved in CAR T cell treatment of patients with R/R DLBCL have to deal with diagnostically complex cases and difficult therapeutic choices.
The availability of novel immunotherapeutic agents for R/R DLBCL and recent advances in understanding CAR T-cell failure mechanisms demand a rational approach to identify the best choice for bridging therapy and managing post-CAR T-cell therapy relapses.
Moreover, positron emission tomography/computerised tomography may result in false-positive interpretation, highlighting the importance of post-treatment biopsy. In this review, we discuss all above issues, presenting four instructive cases, with the aim to provide criteria and new perspectives for CAR T-cell treatment of DLBCL.
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