肿瘤细胞治疗研究
英文原题：Beyond Chemoimmunotherapy: Emerging Cellular and Targeted Therapies in Transformed Follicular Lymphoma: A Scoping Review.
结果部分：共17项研究符合纳入标准，涵盖三大治疗类别：CAR-T疗法（7项干预性试验，报告亚组中t-FL患者共130例）、CD20 CD3双特异性抗体（BsAbs；
引言：转化型滤泡性淋巴瘤（t-FL）是一种侵袭性淋巴瘤，尤其在复发阶段，缺乏足够的前瞻性证据指导治疗。本文总结超越传统化学免疫治疗的新兴细胞疗法及靶向疗法证据。 方法：本范围综述依据范围综述PRISMA扩展声明（PRISMA-ScR）开展，并采用人群-概念-情境（PCC）框架。目标人群为组织学确诊或高度疑似t-FL的成人。研究发现采用叙述性综合。 结果：17项研究符合纳入标准，涵盖三类治疗：CAR-T疗法（7项干预性试验，报告亚组中的t-FL患者共130例）、CD20×CD3双特异性抗体（BsAb；可提取结局的t-FL患者61例）及塞利尼索（31例）；主要干预队列中可提取结局的t-FL患者合计约222例。CAR-T产品的总缓解率（ORR）为52%–83%，完全缓解（CR）率为40%–58%；随机二线试验中，阿基仑赛和利基仑赛优于标准治疗。真实世界CAR-T系列研究中，各登记队列的ORR为82%–92%，CR率为64%–67%。BsAb对经多线治疗的疾病具有活性（埃普可妥单抗ORR 50%、CR率44%；格菲妥单抗ORR 55%、CR率35%），且细胞因子释放综合征以低级别为主。塞利尼索疗效较温和（ORR 39%、CR率16%），但完全缓解者获益持久。 结论：现有证据支持分阶段治疗框架：转化时采用类似DLBCL的诱导治疗；对于适合且对化疗敏感的应答者进行自体干细胞移植；首次复发时优先考虑CAR-T；CAR-T治疗后或不适合细胞疗法时使用BsAb；后线治疗中考虑塞利尼索。仍需纳入t-FL患者的更多前瞻性试验，以优化治疗选择和基于生物标志物的治疗排序。
IntroductionTransformed follicular lymphoma (t-FL) is an aggressive lymphoma with limited prospective evidence to guide treatment, particularly in the relapsed setting. We summarized the current evidence on emerging cellular and targeted therapies that extend beyond conventional chemoimmunotherapy.MethodsThis scoping review was conducted in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) and structured using the Population-Concept-Context (PCC) framework. Adults with histologically confirmed or strongly suspected t-FL were the population of interest. Findings were synthesized narratively.ResultsSeventeen studies met inclusion criteria across three therapeutic categories: CAR-T therapy (7 interventional trials, n = 130 t-FL patients in reported subsets), CD20 CD3 bispecific antibodies (BsAbs; n = 61 t-FL patients with extractable outcomes), and selinexor (n = 31 t-FL patients); together encompassing approximately 222 t-FL patients across primary interventional cohorts with extractable outcomes. CAR-T products achieved overall response rates (ORR) of 52-83% and complete response (CR) rates of 40-58%; randomized second-line trials favored axicabtagene ciloleucel and lisocabtagene maraleucel over standard care. In real-world CAR-T series, ORR ranged from 82-92% and CR rates from 64-67% across registry cohorts. BsAbs were active in heavily pretreated disease (epcoritamab ORR 50%/CR 44%; glofitamab ORR 55%/CR 35%), with predominantly low-grade cytokine release syndrome. Selinexor showed more modest efficacy (ORR 39%/CR 16%) but durable benefit in complete responders.ConclusionsCurrent evidence supports a stepwise treatment framework: DLBCL-like induction at transformation, autologous stem-cell transplant in fit, chemosensitive responders, CAR-T as the preferred option at first relapse, BsAbs after CAR-T or when cellular therapy is not feasible, and selinexor in later-lines of therapy. Additional prospective t-FL-inclusive trials are needed to refine treatment selection and biomarker-guided sequencing.
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