肿瘤细胞治疗研究
英文原题：Circulating tumor DNA determining hyperprogressive disease after CAR-T therapy alarms in DLBCL: a case report and literature review.
CAR-T 细胞疗法（CAR-T）因其良好疗效，已被广泛应用于复发/难治性（R/R）弥漫大 B 细胞淋巴瘤（DLBCL）的临床实践。
由于疗效良好，CAR-T 细胞疗法（CAR-T）已广泛应用于复发/难治性（R/R）弥漫大B细胞淋巴瘤（DLBCL）的临床治疗。高进展性疾病（HPD）因肿瘤进展迅速而受到关注，并已成为治疗和预后方面的挑战。本文报告一例既往多次复发、病情控制良好且仅残留极小肿瘤病灶的患者；其接受CD19/CD22双特异性CAR-T输注，未观察到免疫效应细胞相关神经毒性综合征或细胞因子释放综合征。然而，患者随后迅速恶化；影像学复查、循环肿瘤DNA及血清生物标志物检测均提示HPD。患者对挽救治疗无应答，输注后40天死亡。据我们所知，此前仅报告过1例CAR-T治疗后DLBCL发生HPD的病例。这一致命病例警示HPD风险；我们采用循环肿瘤DNA谱监测这一无创诊断HPD的方法，为CAR-T治疗提供了具有深远意义的实践指导。
Chimeric antigen receptor T-cell therapy (CAR-T) has been widely applied in the clinical practice of relapse/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) due to its promising effects. Hyperprogressive disease (HPD) has gained attention for rapid tumor progression and has become a therapeutic and prognostic challenge. Here, we present a patient who had suffered from several recurrences previously and controlled well with a very small tumor lesion left was infused with CD19/CD22 bispecific CAR-T, with no immune effector cell-associated neurotoxicity syndrome, or cytokine release syndrome observed. However, rapid deterioration, subsequent imaging examination, circulating tumor DNA, and serum biomarkers detection identified HPD. The patient did not respond to salvage treatment and died 40 days after infusion. To our knowledge, only one case of HPD in DLBCL after CAR-T therapy has been reported. This fatal case alarmed the risk of HPD and the ctDNA profile monitoring we used was performed as a non-invasive method to diagnose HPD, providing far-reaching practical instruction for CAR-T therapy.
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