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:Patient-reported outcomes after CAR T-cell therapy in patients with hematological malignancies.
Patient-reported outcomes after CAR T-cell therapy in patients with hematological malignancies.
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接受嵌合抗原受体(CAR)T细胞疗法的血液系统恶性肿瘤患者生存显著改善,这凸显了在患者管理指南中纳入以患者为中心评估的日益迫切需求。CAR-T 疗法具有独特毒性,并且细胞输注后的前几周症状负担相对较高,这已为人熟知。采用患者报告结局(PRO)倾听患者声音,可支持急性照护中的个体化干预、优化医疗资源使用、提高治疗满意度并改善生存获益。
然而,多种因素阻碍了PRO在常规患者照护中的应用:(1)治疗急性期进行PRO评估是否可行,尤其是发生神经毒性的患者,尚未明确;(2)尽管PRO已广泛用于药物开发试验,临床试验评估工具主要用于比较各研究组生活质量或安全性,通常并不适合评估和捕捉常规患者照护中需要监测、且具有临床意义的不良事件;(3)可指导长期生存者监测并捕捉CAR-T 迟发效应的PRO数据有限。亟需克服这些障碍,将循证PRO整合至CAR-T 患者标准治疗指南中。本综述介绍CAR-T 疗法中PRO应用现状,并讨论在患者照护中成功实施PRO的实用方法和未来方向。
The remarkable improvement in survival among individuals with hematological malignancies receiving chimeric antigen receptor (CAR) T-cell therapy has highlighted the growing unmet need to incorporate patient-centered assessments in management guidelines for these patients.
That CAR T-cell therapy is associated with unique toxicities and relatively high symptom burden in the first few weeks after cell infusion is well known. Magnifying the patient's voice by using patient-reported outcomes (PROs) might support personalized intervention in the acute-care setting, optimize the use of medical resources, improve satisfaction with therapy, and enhance survival benefit.
However, various factors impede PRO use in routine patient care: (1) the feasibility of PRO assessment during the acute phase of treatment, especially in patients experiencing neurological toxicities, is not well established; (2) although PROs are widely used in drug- development trials, the assessment tools used in clinical trials primarily inform quality-of-life or safety comparisons among study arms and are rarely the proper tools for assessing and capturing clinically meaningful adverse events that should be monitored in routine patient care; (3) PRO data that could guide how best to monitor and capture the delayed effects of CAR T-cell therapy in long-term survivors are limited.
There is a pressing need to overcome these barriers to integrating evidence-based PROs into standard-of-care guidelines for patients receiving CAR T-cell therapy. In this review, we present the current state of PRO utilization in CAR T-cell therapy.
We also discuss practical approaches and future directions for successful implementation of PROs in the care of patients receiving CAR T-cell therapy.
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