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.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
CAR-T 细胞治疗在 B 细胞淋巴瘤中的应用：随机对照试验的荟萃分析
英文原题：Application of CAR-T cell therapy in B-cell lymphoma: a meta-analysis of randomized controlled trials.
查看英文原题
Application of CAR-T cell therapy in B-cell lymphoma: a meta-analysis of randomized controlled trials.
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研究概要
在治疗 B 细胞淋巴瘤方面，CAR-T 细胞免疫治疗显示出优于标准治疗的疗效。
中文摘要
背景
本研究旨在比较CAR-T 细胞免疫疗法与B细胞淋巴瘤标准治疗的疗效和安全性，为更有效地应用CAR-T 免疫疗法提供循证依据。
方法
我们全面检索万方、Web of Science、中国知网（CNKI）、维普和PubMed数据库中截至2024年2月发表的高质量B细胞淋巴瘤CAR-T 随机对照试验（RCT）。结局指标包括客观缓解率（ORR）、完全缓解率（CRR）和不良反应发生率。根据共刺激结构域差异开展亚组分析。采用Review Manager 5.4和Stata软件进行荟萃分析。
结果
荟萃分析共纳入5项RCT，涉及1,670例患者。与标准治疗组相比，CAR-T 组ORR（RR：1.47，95% CI：1.23–1.76，I²=80%，p<0.0001）、CRR（RR：2.19，95% CI：2.16–3.79，I²=93%，p=0.005）、细胞因子释放综合征（CRS）发生率（RR：34.51，95% CI：2.27–523.78，I²=98%，p=0.01）、神经毒性（NT）发生率（RR：6.00，95% CI：1.82–19.75，I²=80%，p=0.003）、中性粒细胞减少发生率（RR：1.39，95% CI：1.02–1.88，I²=93%，p=0.03）、白细胞减少发生率（RR：1.39，95% CI：1.04–1.87，I²=61%，p=0.03）和头痛发生率（RR：1.56，95% CI：1.25–1.95，I²=34%，p<0.0001）均显著更高。按共刺激结构域开展的亚组分析显示，与CD28组相比，4-1BB组CRR、CRS、NT及白细胞减少发生率较高；但CD28组ORR和中性粒细胞减少发生率高于4-1BB组。
结论
CAR-T 细胞免疫疗法治疗B细胞淋巴瘤的疗效优于标准疗法，但可能导致CRS和NT等不良反应。输注适当剂量的CAR-T 细胞（例如100×10^6个）可能是一种降低CRS和NT风险的策略。
展开英文摘要原文
BACKGROUND
This study aims to compare the efficacy and safety of chimeric antigen receptor T-cell (CAR-T) immunotherapy with standard treatment for B-cell lymphoma, providing evidence-based support for the more efficient use of CAR-T cell immunotherapy.
METHODS
We conducted a comprehensive literature search of high-quality randomized controlled trials (RCTs) on CAR-T therapy for B-cell lymphoma in the following databases: Wanfang, Web of Science, CNKI, VIP database, and PubMed, up to February 2024. The outcome measures included objective remission rate (ORR), complete remission rate (CRR), and incidence of adverse reactions. Subgroup analysis was performed based on the differences in co-stimulatory domains. Meta-analysis was conducted using Review Manager 5.4 and Stata software.
RESULTS
A total of five RCTs involving 1670 patients were included in this meta-analysis. The results showed that the CAR-T treatment group had significantly higher ORR (RR: 1.47, 95% CI 1.23-1.76, I 2 = 80%, p < 0.0001), CRR (RR: 2.19, 95% CI 2.16-3.79, I 2 = 93%, p = 0.005), cytokine release syndrome (CRS) incidence (RR: 34.51, 95% CI 2.27-523.78, I 2 = 98%, p = 0.01), neurotoxicity (NT) incidence (RR: 6.00, 95% CI 1.82-19.75, I 2 = 80%, p = 0.003), neutropenia incidence (RR: 1.39, 95% CI 1.02-1.88, I 2 = 93%, p = 0.03), leukopenia incidence (RR: 1.39, 95% CI 1.04-1.87, I 2 = 61%, p = 0.03), and headache incidence (RR: 1.56, 95% CI 1.25-1.95, I 2 = 34%, p < 0.0001) compared to the standard treatment group. Subgroup analysis based on co-stimulatory domains revealed that the 4-1BB subgroup had higher incidences of CRR, CRS, NT and leukopenia than the CD28 subgroup; however, the CD28 subgroup exhibited higher ORR and neutropenia than the 4-1BB subgroup.
CONCLUSION
CAR-T cell immunotherapy demonstrates superior efficacy compared to standard therapy in treating B-cell lymphoma. However, CAR-T treatment can lead to adverse reactions such as CRS and NT. Infusion of an appropriate dose of CAR-T cells (e.g., 100 10 6 ) may be a strategy to mitigate the risk of CRS and NT.
论文信息
- 作者
- Yu XJ、Liu C、Hu SZ、Yuan ZY、Ni HY、Sun SJ、Hu CY、Zhan HQ
- 第一作者单位
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.China
- 通讯作者单位
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China. heqinzh@163.com.China
- 文献类型
- 荟萃分析
- 期刊
- Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2025 Jun
- 原文标识
- PubMed 39514165 · DOI 10.1007/s12094-024-03774-0