肿瘤细胞治疗研究
英文原题：Allogeneic hematopoietic stem cell transplantation following T-cell-directed immunotherapy failure in B-cell lymphoma: a real-world case series and systematic literature review.
Allogeneic hematopoietic stem cell transplantation following T-cell-directed immunotherapy failure in B-cell lymphoma: a real-world case series and systematic literature review.
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以T细胞为靶点的免疫疗法，包括CAR-T 细胞疗法（CAR-T）和双特异性抗体（BsAbs），已彻底改变了B细胞淋巴瘤的治疗格局，但治疗失败后的选择仍然有限。我们回顾了4例在BsAb或CAR-T 暴露后接受异基因造血干细胞移植（allo-HSCT）的患者，并进行了系统性文献综述。3例患者为大B细胞淋巴瘤，1例为滤泡性淋巴瘤。2例获得持久缓解，而2例出现早期复发或移植相关死亡。文献检索确定了6项研究，评估allo-HSCT作为CAR-T 失败后的挽救治疗或BsAb缓解后的巩固治疗。CAR-T 失败后1年OS超过50%，非复发死亡率为20%至33%。既往CAR-T 暴露并未明确增加移植相关毒性，而BsAb治疗后的allo-HSCT需要警惕感染监测并进一步开展前瞻性评估。Allo-HSCT可作为CAR-T 或BsAb治疗后的有效治愈性治疗，尤其是在疾病得到控制的患者中。
T-cell-directed immunotherapies, including chimeric antigen receptor T-cell therapy (CAR-T) and bispecific antibodies (BsAbs), have revolutionized the management of B-cell lymphomas, yet options after treatment failure remain limited.
We reviewed four patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after BsAb or CAR-T exposure, and performed a systematic literature review. Three patients had large B-cell lymphoma, one had follicular lymphoma. Two achieved durable remission, whereas two experienced early relapse or transplant-related mortality. The literature search identified six studies, evaluating allo-HSCT as salvage therapy after CAR-T failure or as consolidation following BsAb response.
One-year overall survival exceeded 50% after CAR-T failure, with non-relapse mortality ranging from 20% to 33%. Prior CAR-T exposure did not clearly increase transplant-related toxicity, while allo-HSCT following BsAb therapy warrants vigilant infection monitoring and further prospective evaluation. Allo-HSCT may serve as an effective curative treatment after CAR-T or BsAb therapy, particularly in patients with controlled disease.
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