决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:T-cell redirecting therapies for B-cell non-Hodgkin lymphoma: recent progress and future directions.
过去二十年间,B细胞非霍奇金淋巴瘤(B-NHL)治疗领域的若干关键进展,均策略性地利用了适合免疫疗法靶向的B细胞谱系标志物。
过去二十年间,B细胞非霍奇金淋巴瘤(B-NHL)治疗领域的若干关键进展,均策略性地利用了适合免疫疗法靶向的B细胞谱系标志物。首先,将抗CD20单克隆抗体(mAb)利妥昔单抗加入一系列标准治疗方案,在多种临床情境下均带来了显著的疗效改善,其中或许最为突出的是在新诊断的弥漫性大B细胞淋巴瘤(DLBCL)中获得了总生存优势。随后,多种靶向CD19的嵌合抗原受体(CAR)T细胞疗法彻底改变了复发/难治性(rel/ref)DLBCL的治疗格局,并且在其他B-NHL亚型中同样具有活性。最近,通过T细胞重定向疗法,如同时靶向T细胞抗原(如CD3)和肿瘤表达的B细胞抗原(如CD19或CD20)的双特异性抗体(BsAbs),实现了长期以来利用患者内源性T细胞对抗淋巴瘤的夙愿。这些新型药物作为单药治疗,在多种亚型、经重度预处理的rel/ref B-NHL患者中展现出令人瞩目的活性。目前,大量临床试验正在探索T细胞重定向药物与靶向治疗、抗体药物偶联物、常规化疗乃至新型免疫疗法的联合应用。在此,我们重点回顾B-NHL T细胞重定向疗法发展过程中的关键里程碑、近期临床试验带来的新证据与经验教训,以及该领域令人振奋的新方向。
Several key advances in the treatment of B-cell non-Hodgkin lymphoma (B-NHL) over the past two decades have strategically exploited B-cell lineage markers suitable for targeting by immunotherapies. First, the addition of the anti-CD20 monoclonal antibody (mAb) rituximab to a range of standard therapies conferred remarkable outcomes improvements in diverse settings, perhaps most prominently an overall survival advantage in newly diagnosed diffuse large B-cell lymphoma (DLBCL). Subsequently, multiple chimeric antigen receptor (CAR) T-cell therapies targeting CD19 have revolutionized the treatment of relapsed/refractory (rel/ref) DLBCL and are active in other B-NHL subtypes as well. Most recently, the longstanding aspiration to exploit patients' endogenous T-cells to combat lymphoma has been achieved via T-cell redirecting therapies such as bispecific antibodies (BsAbs) that incorporate dual targeting of a T-cell antigen such as CD3 plus a B-cell antigen such as CD19 or CD20 expressed by the tumor. These novel agents have demonstrated impressive activity as monotherapies in patients with heavily pre-treated, rel/ref B-NHL of a variety of subtypes. Now, myriad clinical trials are exploring combinations of T-cell redirectors with targeted therapies, antibody-drug conjugates, conventional chemotherapy, and even new immunotherapies. Here, we highlight key landmarks in the development of T-cell redirecting therapies for the treatment of B-NHL, emerging evidence and lessons from recent clinical trials, and exciting new directions in this arena.
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