非霍奇金淋巴瘤中 CAR-T 细胞治疗的桥接放疗：系统综述与 meta 分析

PubMed, MEDLINE and EMBASE were searched until 13 April 2025 for adult NHL studies adopting BRT before CART therapy. Primary endpoints were 1-year overall survival (OS) and progression-free survival (PFS); secondary endpoints were objective response rate (ORR), in-field failure and grade ≥ 3 cytokine-release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS). Random-effects model was used for pooled estimates. Meta-regression was done to explore clinical covariates.

Fifteen studies including 636 patients were reviewed. Pooled 1-year OS was 67 % and 1-year PFS was 52 %. Pooled ORR was 79 % with complete response rate of 57 %. Pooled in-field failure was 11 %. Pooled Grade ≥ 3 CRS was 5 % while Grade ≥ 3 ICANS was 6 %. Bulky, extra-nodal or advanced-stage disease were associated with worse 1-year OS but not with 1-year PFS nor CART toxicity. Comprehensive BRT covering all lesions was associated with improved 1-year PFS and RT doses > 30 Gy EQD2 was associated with 1-year PFS.

BRT leads favourable survival outcome and durable local control while maintaining low rate of severe CRS/ICANS. Comprehensive, adequately dosed irradiation may optimise tumour-burden reduction and improve 1-year PFS. Further prospective studies are warranted to refine RT dose, field coverage and patient selection.