肿瘤细胞治疗研究
英文原题：Characteristics and utilization of the three BCMA-targeted therapies in multiple myeloma.
Characteristics and utilization of the three BCMA-targeted therapies in multiple myeloma.
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近年来，多发性骨髓瘤的治疗取得了显著进展，患者预后明显改善，这主要归功于多种治疗方式的引入。本综述聚焦于三种BCMA靶向疗法：抗BCMA CAR-T 细胞疗法、双特异性抗体（BsAb）疗法和抗体药物偶联物（ADC）疗法。BCMA是一种主要表达于骨髓瘤细胞的膜结合蛋白，由于其正常组织表达有限，可最大限度减少脱靶毒性，因而是一个有前景的靶点。
我们探讨了这些疗法的特征、疗效和安全性，重点阐述了总缓解率和潜在不良反应方面的差异。抗BCMA CAR-T 疗法，如idecabtagene vicleucel（ide-cel）和ciltacabtagene autoleucel（cilta-cel），表现出不同的缓解率和持久性，其中cilta-cel显示出平台期，提示可能实现长期缓解。相比之下，teclistamab和elranatamab等BsAb疗法提供了即用型治疗选择，但可能导致T细胞耗竭。以belantamab mafodotin为代表的ADC疗法面临独特挑战，尤其是眼部毒性方面。
此外，治疗序贯至关重要，因为既往接受过一种治疗可能影响后续治疗的疗效。本综述强调在启动治疗前评估BCMA表达和T细胞耗竭的必要性，并倡导精心构建治疗方案以优化多发性骨髓瘤患者的结局。
Recent advancements in the treatment of multiple myeloma have significantly improved patient outcomes, primarily due to the introduction of various therapeutic modalities. This review focuses on three BCMA-targeted therapies: anti-BCMA CAR-T cell therapy, bispecific antibody (BsAb) therapy, and antibody-drug conjugate (ADC) therapy. BCMA, a membrane-bound protein predominantly expressed on myeloma cells, presents a promising target due to its limited expression in normal tissues, minimizing off-target toxicity.
We explore the characteristics, efficacy, and safety profiles of these therapies, highlighting the differences in overall response rates and potential adverse effects. Anti-BCMA CAR-T therapies, such as idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), exhibit varying response rates and durability, with cilta-cel showing a plateau phase suggesting potential long-term remission.
In contrast, BsAb therapies like teclistamab and elranatamab provide off-the-shelf treatment options but may lead to T-cell exhaustion. ADC therapy, represented by belantamab mafodotin, poses unique challenges, particularly concerning ocular toxicity.
Furthermore, treatment sequencing is critical, as prior exposure to one therapy can influence the efficacy of subsequent treatments. This review emphasizes the necessity of assessing BCMA expression and T-cell exhaustion before initiating therapy, and advocates for carefully constructed treatment regimens to optimize outcomes for patients with multiple myeloma.
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