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:Idecabtagene vicleucel (ide-cel) for the treatment of triple-class exposed relapsed and refractory multiple myeloma.
现代抗骨髓瘤疗法在该疾病的治疗中开辟了新领域,而ide-cel纳入治疗格局代表了重大的科学和临床进展之一。
引言:现代抗骨髓瘤治疗带来了重大突破,伊德卡博他仑(ide-cel)纳入治疗体系是重要的科学和临床进展之一。 综述范围:Ide-cel是首个获批用于对三类药物均有暴露的复发/难治性骨髓瘤患者的细胞基因疗法,显示出令人瞩目的结果。对于既往接受大量治疗及高危疾病患者,与标准方案相比,该疗法在疗效、潜在无治疗间隔和生活质量改善方面具有优势。本综述总结近期ide-cel应用进展,涵盖正在进行或即将开展的临床试验及真实世界经验。 专家意见:随着嵌合抗原受体(CAR)T细胞疗法使用预计会逐渐增加,且现有适应证会拓展至更早治疗线,应致力于改进整体管理,以主动规划治疗顺序并为物流安排预留充足时间。重要的是,CAR-T疗法的潜在供应有限,凸显谨慎选择患者及加强中心间协调的必要性。同时,研究者正在努力提高耐受性、减轻毒性并增强抗骨髓瘤活性。
INTRODUCTION: Modern anti-myeloma therapies have broken new ground in the treatment of the disease, and the incorporation of ide-cel in the treatment landscape represents one of the major scientific and clinical advances. AREAS COVERED: Ide-cel was the first cell-based gene therapy approved for the treatment of triple-class exposed relapsed/refractory myeloma patients, showing impressive results, and demonstrating superiority over standard regimens in terms of efficacy, potential treatment-free intervals, and improved quality of life in heavily pretreated patients and in high-risk disease. This review summarizes the state-of-the-art of the most recent updates deriving from the use of ide-cel within ongoing, or upcoming, clinical trials, and from real-life experiences. EXPERT OPINION: As the use of chimeric antigen receptor (CAR)-T therapy is likely to progressively increase over time and current indications expand to earlier treatment lines, efforts should be directed toward ameliorating overall management to facilitate proactive planning for treatment sequencing and provide adequate time for logistical planning. Importantly, the potential limited availability of CAR-T therapy highlights the importance of careful patient selection and coordination among centers. Meanwhile, attempts are underway to improve tolerance and reduce toxicity while enhancing anti-myeloma activity.
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