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:Burden and management of infectious diseases in patients treated by chimeric antigen-receptor T (CAR-T)-cell therapy for refractory or relapsing diffuse large B-cell lymphoma or multiple myeloma.
CAR-T 细胞疗法已彻底改变了复发/难治性 B 细胞淋巴瘤(BCL)和多发性骨髓瘤(MM)的治疗格局。
CAR-T 细胞疗法革新了复发/难治性 B 细胞淋巴瘤(BCL)和多发性骨髓瘤(MM)的治疗格局。尽管疗效显著,一个重大且常危及生命的并发症是严重感染及感染相关死亡风险升高,这源于深度且持久的免疫抑制。本文回顾 CAR-T 治疗相关的多样感染负担,按不同治疗阶段(CAR-T 前、早期、持续期和晚期)分类讨论风险及管理,并详述临床试验和真实世界数据中观察到的细菌、病毒和真菌感染发生率及类型。此外,文章总结感染风险管理综合策略,包括输注前筛查、主动和被动免疫预防,以及根据治疗阶段制定的药物干预。鉴于 CAR-T 特异性感染管理数据的复杂性和现有限制,本文强调血液科医生与感染病专科医生开展多学科协作,对于优化患者结局至关重要。
Chimeric Antigen Receptor T-cell (CAR-T) therapy has revolutionized the treatment landscape for relapsed/refractory B-cell lymphomas (BCL) and multiple myeloma (MM). Despite its remarkable efficacy, a significant and often life-threatening complication is the elevated risk of severe infections and infection-related mortality, stemming from profound and prolonged immunosuppression. This paper reviews the diverse infection burden associated with CAR-T therapy, categorizing risks across distinct treatment phases (pre-CAR-T, early, prolonged, and late) and their management. It details the frequency and types of bacterial, viral, and fungal infections observed in clinical trials and real-world data. Furthermore, it outlines comprehensive strategies for managing infection risk, including pre-infusion screening, active and passive immunoprophylaxis, and pharmacological interventions tailored to each phase of therapy. The report emphasizes the critical need for a collaborative, multidisciplinary approach involving hematologists and infectious disease specialists to optimize patient outcomes given the complexity and current limitations in robust, CAR-T-specific infection management data.
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