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
接受三线 CAR-T 治疗的复发/难治性大 B 细胞淋巴瘤患者桥接治疗的结局
英文原题：Outcomes of Bridging Therapy in Patients With Relapsed/Refractory Large B Cell Lymphoma Receiving Third-Line CAR T.
查看英文原题
Outcomes of Bridging Therapy in Patients With Relapsed/Refractory Large B Cell Lymphoma Receiving Third-Line CAR T.
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中文摘要
桥接治疗（BT）常用于接受CAR-T 细胞治疗的复发/难治性（R/R）大B细胞淋巴瘤（LBCL）患者，但最佳BT方案仍不确定。
我们评估了BT策略及其与缓解和生存结局的关联。据此，我们纳入了2017年至2024年在Princess Margaret癌症中心接受三线或更后线CD19靶向CAR-T 评估的R/R LBCL患者（随访至2025年1月）。BT方式包括化疗、基于polatuzumab的化疗、放疗、皮质类固醇和无BT。
我们使用logistic回归和Cox模型评估了BT方式与总缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）的关联。在219例患者中，188例接受了单采，157例（84%）接受了CAR-T。在单采患者中，79%接受了BT（放疗41%，基于polatuzumab的方案26%，三线化疗16%，皮质类固醇17%，而21%未接受BT）。ORR在polatuzumab（50%）和放疗（40%）中最高，优于化疗（16%）（p = 0.009）。84例患者的中位SUVmax在polatuzumab和放疗治疗患者中高于化疗（p < 0.001）。涵盖所有活动性病灶的放疗ORR更高（51%），优于非全面放疗（12%）（p = 0.04）。2年PFS在放疗（47%）和polatuzumab（37%）BT中最高，优于化疗（21%）。校正分析显示，放疗（校正风险比[aHR] 0.29）和polatuzumab（aHR 0.41）可改善PFS。OS也在放疗中改善（HR 0.40）。化疗BT与最高的2年淋巴瘤相关死亡率（74%）相关。
总之，与化疗相比，基于polatuzumab的桥接治疗、放疗桥接治疗以及未进行桥接治疗均与更好的缓解率和结局相关。尽管这些结果可能受到患者选择的影响，但仍需要整合这些方法的前瞻性研究来定义最佳、个体化的桥接治疗策略。
展开英文摘要原文
Bridging therapy (BT) is frequently used in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) undergoing chimeric antigen receptor T cell (CAR T) therapy, but the optimal BT approach remains uncertain.
We evaluated BT strategies and their associations with response and survival outcomes. Accordingly, we included patients with R/R LBCL evaluated for third-line or later CD19-directed CAR T at Princess Margaret Cancer Center from 2017 to 2024 (follow-up to 01/2025). BT modalities included chemotherapy, polatuzumab-based chemotherapy, radiotherapy, corticosteroids, and none.
We assessed the associations of BT modality with overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) using logistic regression and Cox models. Among 219 patients, 188 underwent apheresis and 157 (84%) received CAR T. Of those apheresed, 79% received BT (radiotherapy 41%, polatuzumab-based 26%, third-line chemotherapy 16%, corticosteroids 17%, while 21% received no BT). ORR was highest with polatuzumab (50%) and radiotherapy (40%) versus chemotherapy (16%) (p = 0. 009).
Median SUVmax in 84 patients was higher in polatuzumab and radiotherapy treated patients, compared to chemotherapy (p < 0. 001). Radiotherapy encompassing all active disease had higher ORR (51%) versus non-comprehensive (12%) (p = 0. 04). Two-year PFS was highest with radiotherapy (47%) and polatuzumab (37%) BT versus chemotherapy (21%).
Adjusted analyses showed improved PFS with radiotherapy (adjusted hazard ratio [aHR] 0. 29) and polatuzumab (aHR 0. 41). OS was also improved with radiotherapy (HR 0. 40). Chemotherapy BT was associated with the highest 2-year lymphoma-related mortality (74%).
In conclusion, polatuzumab-based and radiotherapy BT as well as no BT were associated with improved responses and outcomes compared to chemotherapy. Although these results may have been influenced by patient selection, prospective studies integrating these approaches are needed to define optimal, individualized BT strategies.
论文信息
- 作者
- Gong IY、Jeeva M、Hueniken K、Aminilari M、Marinoni M、Prica A、Rodin D、Bhella S
- 单位
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Canada
- 期刊
- Hematological oncology2026 Mar
- 原文标识
- PubMed 41774783 · DOI 10.1002/hon.70183