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:Emerging immunotherapy advances for non-Hodgkin lymphomas: engaging T cells in the fight.
B细胞非霍奇金淋巴瘤(B-NHL)的治疗格局因T细胞衔接(TCE)疗法的出现而迅速改变。
B细胞非霍奇金淋巴瘤(B-NHL)的治疗格局因T细胞衔接(TCE)疗法的出现而迅速改变。在过去十年中,抗CD19嵌合抗原受体(CAR)T细胞疗法已从复发/难治性场景推进至侵袭性大B细胞淋巴瘤的二线治疗,目前也已获批用于R/R滤泡性淋巴瘤、套细胞淋巴瘤和慢性淋巴细胞白血病。更近期,同时靶向CD20和CD3的双特异性抗体已作为替代性TCE选择出现,并已获批作为单药疗法用于多种复发/难治性B细胞淋巴瘤。TCE疗法的常见研究主题包括在治疗范式中更早整合、测试联合方案以及考虑最佳序贯策略。尽管取得了重大进展,技术创新的机会仍然存在,可能改善疗效、减轻毒性,并简化治疗实施中有时较为复杂的物流环节。替代靶点和多抗原靶点正在CAR T细胞构建体以及双特异性抗体中进行探索,其中一些方法现已进入早期临床试验。改善CAR T制造、优化T细胞适应性以及设计新型“装甲”CAR T细胞的策略正在临床前和早期临床数据中积极测试。从安全性角度来看,在减轻副作用负担和扩大可及性方面已取得很大进展;然而,在TCE疗法能够广泛惠及所有患者之前,障碍仍然存在。这篇简要综述讨论了正在测试的一些最新策略,以将TCE疗法提升为B-NHL免疫治疗的支柱。
The treatment landscape of B-cell non-Hodgkin lymphoma (B-NHL) has been rapidly transformed by the emergence of T-cell engaging (TCE) therapies. Within the past decade, anti-CD19 chimeric antigen receptor (CAR) T-cell therapies have moved from relapsed/refractory to second-line settings in aggressive large B-cell lymphomas and are now also approved for R/R follicular lymphoma, mantle cell lymphoma, and chronic lymphocytic leukemia. More recently, bispecific antibodies with dual engagement of CD20 CD3 have emerged as an alternative TCE option with regulatory approval as monotherapies in several relapsed/refractory B-cell lymphomas. Common investigational themes for TCE therapies include earlier integration in the treatment paradigm, testing combination approaches, and considering optimal sequencing approaches. Despite major progress, there remains opportunity for technical innovations that may improve efficacy, attenuate toxicity, and ease the sometimes complex logistics around treatment delivery. Alternative and multiantigen targets are being explored in CAR T-cell constructs as well as bispecific antibodies, with some of these approaches now in early-phase clinical trials. Strategies to improve CAR T manufacturing, optimize T-cell fitness, and design novel "armored" CAR T-cells designs are actively being tested in preclinical and early-phase clinical data. From a safety perspective, much progress has been made in reducing the burden of side effects and broadening access; however, barriers remain before TCE therapies can be widely available to all patients. This brief review addresses some of the latest strategies being tested to elevate TCE therapies as pillars of immunotherapy for B-NHL.
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