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:Put the CAR-T before the HRS: Advances in Anti-CD30 Immunotherapy Targeting Hodgkin/Reed-Sternberg Cells in Classical Hodgkin Lymphoma.
这些数据表明,除了brentuximab vedotin的既定作用外,靶向CD30的CAR-T细胞和双特异性抗体在难治性cHL中表现出高活性,特别是在使用含氟达拉滨的淋巴细胞清除方案时,联合程序性细胞死亡1(PD-1)受体阻断作为清除微小残留病的策略。
经典霍奇金淋巴瘤(cHL)的特征是稀有的霍奇金/Reed-Sternberg(HRS)肿瘤细胞均一表达分化簇(CD)30分子并构建免疫抑制性肿瘤微环境,使CD30成为具有吸引力的选择性治疗靶点。我们总结了CD30作为治疗靶点的生物学依据以及各主要平台的临床前和临床证据:抗体-药物偶联物(brentuximab vedotin)、单克隆抗体(包括acimtamig及其与NK 细胞的联合方案)、第二和第三代嵌合抗原受体(CAR)-T细胞以及替代治疗模式。特别关注标准化疗效评估(IWG、Lugano、RECIL标准),以实现适当的跨试验比较。综合来看,数据表明,除brentuximab vedotin已确立的作用外,CD30靶向CAR-T细胞和双特异性抗体在难治性cHL中表现出高活性,尤其是在使用含氟达拉滨的淋巴细胞清除方案时,联合程序性细胞死亡1(PD-1)受体阻断作为清除微小残留病灶的策略。关键挑战包括效应细胞的持久存续以及序贯治疗和联合方案的优化;值得注意的是,CD30丢失作为逃逸机制似乎并不常见。将HRS生物学的机制性见解与临床试验数据相结合,凸显了增强CD30靶向免疫治疗疗效、安全性和可及性的策略。本综述旨在提供CD30靶向方法在cHL中的简明概述,重点关注治疗结局和CAR-T技术的演变。
Classical Hodgkin lymphoma (cHL) is characterized by rare Hodgkin/Reed-Sternberg (HRS) tumor cells that uniformly express cluster of differentiation (CD)30 molecules and orchestrate an immunosuppressive tumor microenvironment, making CD30 an attractive and selective therapeutic target. We summarize the biological rationale for CD30 as a therapeutic target and the preclinical and clinical evidence across major platforms: antibody-drug conjugates (brentuximab vedotin), monoclonal antibodies (including acimtamig and its combinations with Natural Killer cells), second- and third-generation chimeric antigen receptor (CAR)-T cells, and alternative modalities. Particular attention is given to standardized response assessment (IWG, Lugano, RECIL criteria), which enables appropriate cross-trial comparisons. Taken together, the data indicate that beyond the established role of brentuximab vedotin, CD30-directed CAR-T cells and bispecific antibodies demonstrate high activity in refractory cHL, especially when used with fludarabine-containing lymphodepletion, combined with programmed cell death 1 (PD-1) receptor blockade as a strategy to eradicate minimal residual disease. Key challenges include durable effector-cell persistence and optimization of sequencing and combinations; notably, loss of CD30 as an escape mechanism appears uncommon. Integrating mechanistic insights into HRS biology with clinical trial data highlights strategies to enhance the efficacy, safety, and accessibility of CD30-directed immunotherapy. This review aims to provide a concise overview of CD30-targeted approaches in cHL, emphasizing therapeutic outcomes and the evolution of CAR-T technologies.
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