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:The future of immunotherapy for diffuse large B-cell lymphoma.
随着抗CD19嵌合抗原受体(CAR)T细胞(CAR T)疗法、双特异性CD3/CD20抗体和抗CD19抗体的引入,免疫治疗持续改变着弥漫性大B细胞淋巴瘤(DLBCL)的治疗格局。
随着抗CD19嵌合抗原受体(CAR)T细胞(CAR T)疗法、双特异性CD3/CD20抗体和抗CD19抗体的引入,免疫治疗持续改变着弥漫性大B细胞淋巴瘤(DLBCL)的治疗格局。目前有多种新型免疫治疗策略正在研究中,旨在巩固现有临床获益,并为那些因年龄和/或健康状况而无法耐受传统强化治疗的患者提供更多选择。除了利用适应性免疫应答的免疫疗法外,自然杀伤(NK)细胞和髓系细胞衔接疗法可以利用固有免疫系统。经过工程化改造以增强患者免疫系统识别能力的单克隆抗体,可以增强由NK细胞和巨噬细胞介导的抗肿瘤细胞毒机制。此外,CAR技术正在向NK细胞和巨噬细胞拓展,针对巨噬细胞/髓系细胞检查点通过CD47/SIRP轴的研究性免疫检查点抑制剂也正在开发中。同时调动固有免疫和适应性免疫应答的方案可能有助于克服对当前免疫疗法的耐药性。此外,免疫治疗与致癌通路抑制剂的联合应用,以重编程DLBCL的免疫抑制性肿瘤微环境,也可能增强抗肿瘤应答。随着免疫治疗选择在一线治疗和后续治疗中不断扩展,理解如何利用这些免疫疗法以及联合治疗方案的潜力,对于未来DLBCL治疗策略的开发将至关重要。
With the introduction of anti-CD19 chimeric antigen receptor (CAR) T-cell (CAR T) therapies, bispecific CD3/CD20 antibodies and anti-CD19 antibodies, immunotherapy continues to transform the treatment of diffuse large B-cell lymphoma (DLBCL). A number of novel immunotherapeutic strategies are under investigation to build upon current clinical benefit and offer further options to those patients who cannot tolerate conventional intensive therapies due to their age and/or state of health. Alongside immunotherapies that leverage the adaptive immune response, natural killer (NK) cell and myeloid cell-engaging therapies can utilize the innate immune system. Monoclonal antibodies engineered for greater recognition by the patient's immune system can enhance antitumor cytotoxic mechanisms mediated by NK cells and macrophages. In addition, CAR technology is extending into NK cells and macrophages and investigational immune checkpoint inhibitors targeting macrophage/myeloid cell checkpoints via the CD47/SIRP axis are in development. Regimens that engage both innate and adaptive immune responses may help to overcome resistance to current immunotherapies. Furthermore, combinations of immunotherapy and oncogenic pathway inhibitors to reprogram the immunosuppressive tumor microenvironment of DLBCL may also potentiate antitumor responses. As immunotherapy treatment options continue to expand, both in the first-line setting and further lines of therapy, understanding how to harness these immunotherapies and the potential for combination approaches will be important for the development of future DLBCL treatment approaches.
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