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:Resistance pathways and next-generation treatments in chronic lymphocytic leukemia.
慢性淋巴细胞白血病 (CLL) 仍然是淋巴系统恶性肿瘤最常见的类型,然而,尽管过去十年治疗方法取得了众多进展,CLL 仍继续构成重要的临床挑战。
慢性淋巴细胞白血病(CLL)仍是最常见的淋巴系统恶性肿瘤;然而,尽管过去十年治疗方法不断发展,CLL仍带来重要临床挑战。目前多数治疗靶向B细胞受体信号,包括靶向布鲁顿酪氨酸激酶(BTK)或B细胞淋巴瘤2(BCL-2);磷脂酰肌醇3-激酶(PI3K)抑制剂在当前临床实践中的作用则较有限。这些药物已显著改变CLL病程,但耐药,尤其是对共价BTK抑制剂和维奈克拉的耐药,仍是重要问题,推动了多种新策略的发展:采用非共价方式靶向BTK、降解BTK、CAR-T(CAR-T)细胞疗法及双特异性抗体。此外,关于CLL微环境的新发现揭示,中性粒细胞重编程和髓源性抑制细胞(MDSC)等成分可促进癌细胞存活并导致治疗耐药。因此,耐药问题已变得复杂,治疗需要同时靶向癌细胞及其周围微环境。未来治疗可能采用由预测性生物标志物指导的联合疗法。
Chronic lymphocytic leukemia (CLL) is still the most common form of lymphoid malignancy, however, despite numerous developments in therapeutic approaches over the last ten years, CLL continues to pose important clinical challenges. The majority of currently available treatments target B-cell receptor signaling through either targeting Bruton Tyrosine Kinase (BTK) or B-cell Lymphoma 2 (BCL-2), while Phosphoinositide 3-Kinase (PI3K) inhibitors play a more limited role in current clinical practice. These agents have significantly changed the course of CLL disease; nevertheless, drug resistance, especially to covalent BTK inhibitors and venetoclax, remains an important problem that has led to the development of several new approaches: targeting BTK via a noncovalent approach, BTK degradation, Chimeric Antigen Receptor T (CAR-T) cell therapy, and bispecific antibodies. Moreover, novel discoveries concerning the microenvironment of CLL have been reported, revealing how components such as neutrophil reprogramming and myeloid-derived suppressor cells (MDSCs) can promote cancer cell survival and lead to resistance to treatment. Thus, from the discussion above, it is clear that the resistance problem has become complicated and complex and requires the targeting of not only cancer cells but also the environment surrounding them. Future treatments will likely involve combination therapy based on predictive biomarkers.
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