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:Emerging role of lisocabtagene maraleucel chimeric antigen receptor-T cell in nodal and gastrointestinal follicular lymphoma.
Emerging role of lisocabtagene maraleucel chimeric antigen receptor-T cell in nodal and gastrointestinal follicular lymphoma.
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嵌合抗原受体(CAR)-T 细胞疗法已成为复发/难治性滤泡性淋巴瘤(FL)的一种变革性治疗选择,尤其是在多线常规治疗失败的患者中。在靶向分化簇(CD)19的产品中,lisocabtagene maraleucel(liso-cel)因其明确的 CD4+/CD8+ 组成和良好的安全性特征而具有独特优势。与弥漫性大 B 细胞淋巴瘤相比,FL 患者始终获得更高的总缓解率,并且表现出更低的重度细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征发生率,这支持了在该亚组中扩大 CAR-T 细胞治疗的理由。
本社论回顾了当前靶向 CD19 的 CAR-T 细胞治疗格局,重点关注关键的 TRANSCEND FL 试验,该试验显示总缓解率为 97%,完全缓解率为 94%,重度 CRS 或神经毒性发生率极低。比较性见解突出了 liso-cel 相较于其他 CAR-T 细胞产品(如 axicabtagene ciloleucel 和 tisagenlecleucel)在毒性、物流和门诊可行性方面的优势。本文还讨论了其对胃肠道 FL(GI-FL)的意义,该亚型常被排除在 CAR-T 细胞研究之外,并强调有必要在未来的评估中纳入晚期 GI-FL 病例。随着生产、可及性和生物标志物开发的持续改进,liso-cel 有望成为 FL 不断演变的治疗范式中的核心组成部分。
然而,在缓解持久性、成本和可及性方面仍存在挑战,值得仔细讨论。
Chimeric antigen receptor (CAR)-T cell therapy has emerged as a transformative treatment option for relapsed or refractory follicular lymphoma (FL), particularly in patients in whom multiple lines of conventional therapy have failed. Among cluster of differentiation (CD) 19-targeted products, lisocabtagene maraleucel (liso-cel) offers distinct advantages owing to its defined CD4 + /CD8 + composition and favorable safety profile. Compared with diffuse large B-cell lymphoma, FL patients consistently achieve higher overall response rates and exhibit lower rates of severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome, supporting the rationale for expanding CAR-T cell therapy in this subgroup.
This editorial review the current CD19-directed CAR-T cell therapy landscape, focusing on the pivotal TRANSCEND FL trial, which demonstrated a 97% overall response rate and 94% complete response rate, with a minimal incidence of severe CRS or neurotoxicity. Comparative insights highlight the advantages of liso-cel over other CAR-T cell products, such as axicabtagene ciloleucel and tisagenlecleucel in terms of toxicity, logistics, and outpatient feasibility.
The implications for gastrointestinal FL (GI-FL), a subtype often excluded from CAR-T cell studies, were also addressed, emphasizing the need to include advanced-stage GI-FL cases in future evaluations. With ongoing improvements in manufacturing, accessibility, and biomarker development, liso-cel is well-positioned to become a central component in the evolving treatment paradigm for FL.
However, challenges remain regarding durability of response, cost, and access, which warrant careful discussion.
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