CAR-T(CAR-T)细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CAR-T(CAR-T)细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Immune Effector Cell-Associated HLH-like Syndrome: A Review of the Literature of an Increasingly Recognized Entity.
Immune Effector Cell-Associated HLH-like Syndrome: A Review of the Literature of an Increasingly Recognized Entity.
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自CAR-T 细胞疗法于2017年首次获批以来,其应用日益普及,相关副作用也随之受到更多关注。CAR-T 相关噬血细胞性淋巴组织细胞增多症(HLH),亦称免疫效应细胞相关HLH样综合征(IEC-HS),虽罕见,但若未能及时识别可致命。我们回顾相关文献,以了解IEC-HS的发生率,并阐明诊断标准和治疗建议的发展情况。IEC-HS发生率因CAR-T 产品和所治疗恶性肿瘤类型而异。由于目前缺乏标准化诊断标准,且其临床表现可能与细胞因子释放综合征及活动性血液系统疾病重叠,诊断具有挑战性。建议治疗策略依据既往HLH治疗经验制定,包括使用阿那白滞素、糖皮质激素和鲁索替尼。IEC-HS是CAR-T 治疗相关的一种潜在致命毒性;要改善患者结局,必须尽早识别,建立可靠诊断标准,并及时采用针对IEC-HS的治疗。
Since CAR-T cell therapy was initially approved in 2017, its use has become more prevalent and so have its side effects. CAR-T-related HLH, also named immune effector cell-associated HLH-like syndrome (IEC-HS), is a rare but fatal toxicity if not recognized promptly.
We conducted a review of the literature in order to understand the prevalence of IEC-HS as well as clarify the evolution of the diagnostic criteria and treatment recommendations. IEC-HS occurrence varies between CAR-T cell products and the type of malignancy treated. Diagnosis can be challenging as there are no standardized diagnostic criteria, and its clinical features can overlap with cytokine release syndrome and active hematological disease.
Suggested treatment strategies have been extrapolated from prior experience in HLH and include anakinra, corticosteroids and ruxolitinib. IEC-HS is a potentially fatal toxicity associated with CAR-T cell therapy. Early recognition with reliable diagnostic criteria and prompt implementation of treatment specific to IEC-HS is imperative for improving patient outcomes.
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