CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
我如何治疗免疫治疗后复发的 B-ALL
英文原题：How I treat postimmunotherapy relapsed B-ALL.
查看英文原题
How I treat postimmunotherapy relapsed B-ALL.
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中文摘要
尽管B细胞急性淋巴细胞白血病（B-ALL）单抗原靶向治疗取得显著进展，无应答和复发仍是主要挑战。接受blinatumomab或靶向CD19嵌合抗原受体（CAR）T细胞治疗后可能发生抗原逃逸，表现为CD19阴性B-ALL或谱系转换（LS）为急性髓系白血病，给诊断和治疗带来复杂问题。输注后复发患者结局较差，尤其是靶抗原丢失者，因此必须采用系统化诊疗策略。本文按CD19阳性复发、CD19阴性复发和谱系转换分类，提出处理免疫治疗后事件的系统方法。讨论的治疗包括再次输注CD19 CAR-T、人源化CAR构建体、联合策略，以及blinatumomab和inotuzumab等替代抗原靶向疗法。针对抗原逃逸导致的诊断挑战，文章强调下一代测序及多参数流式细胞术监测髓系标志物的作用。
展开英文摘要原文
Despite significant advancements in single-antigen targeted therapies for B-cell acute lymphoblastic leukemia (B-ALL), nonresponse and relapse persist as major challenges. Antigen escape after blinatumomab or CD19-directed chimeric antigen receptor (CAR) T cells (CD19-CAR), as CD19-negative B-ALL or lineage switch (LS) to acute myeloid leukemia, present diagnostic and treatment complexities.
Given the poor outcomes for patients experiencing a postinfusion relapse, particularly those with loss of the target antigen, a strategic approach to diagnosis and treatment is imperative. In this discussion, we outline a systematic approach to managing postimmunotherapy events, categorized by CD19-positive relapse, CD19-negative relapse, and LS.
We explore treatment modalities including CD19-CAR reinfusions, humanized CAR constructs, combinatorial strategies, and alternative antigen-targeted therapies, such as blinatumomab and inotuzumab. Challenges in diagnosis, particularly with antigen-escape, are addressed, highlighting the role of next-generation sequencing and multiparameter flow cytometry for myeloid marker monitoring.
论文信息
- 作者
- Lamble AJ、Kovach AE、Shah NN
- 第一作者单位
- Department of Pediatric Hematology and Oncology, Seattle Children's Hospital, University of Washington, Seattle, WA.United States
- 通讯作者单位
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.United States
- 文献类型
- 病例报告 · 综述 · 美国 NIH 院内研究
- 期刊
- Blood2025 Jan 2
- 原文标识
- PubMed 39046821 · DOI 10.1182/blood.2024024517
在 PubMed 查看 → 出版商原文（DOI） 全文 PDF（PMC）· 可下载 治疗专题与资料阅读指南 资料来源与翻译说明 报告译文或资料问题 →