肿瘤细胞治疗研究
英文原题：Outcomes of CAR T-Cell Therapy in transformed indolent Non-Hodgkin Lymphomas and de novo DLBCL: A comparative analysis from the Italian CAR T-SIE study.
接受 CAR T 细胞治疗的 TiNHL 患者比 dnDLBCL 患者获得更好的结局，且安全性相当，支持其作为 TiNHL 标准治疗的应用。
背景：转化型惰性非霍奇金淋巴瘤（TiNHL）的结局通常较新发弥漫性大B细胞淋巴瘤（dnDLBCL）差。抗CD19 CAR-T细胞疗法已成为复发/难治性（R/R）大B细胞淋巴瘤（LBCL）的标准治疗，但其在不同组织学亚型中的预后作用尚不清楚。 方法：我们开展多中心回顾性/前瞻性观察研究，比较纳入意大利CART-SIE研究、接受商业化CAR-T治疗的R/R TiNHL与R/R dnDLBCL患者。 结果：438例患者中，107例为TiNHL（96例转化型滤泡性淋巴瘤[tFL]、11例转化型边缘区淋巴瘤[tMZL]），331例为dnDLBCL。两组基线特征相近。TiNHL患者总缓解率（83%比69%）和完全缓解率（62%比53%）更高（两项均p<0.01），2年无进展生存期（PFS：44%比31%）及总生存期（OS：61%比48%）也更优（两项均p<0.01）。CAR-HEMATOTOX评分可预测较差结局（PFS HR=2.10；OS HR=3.57）。tFL与tMZL间未发现显著差异。TiNHL患者2年复发/进展发生率更低（28%比47%，p<0.01），非复发死亡率相近（11%比4%，p=0.12）。包括细胞因子释放综合征和ICANS发生率在内的安全性特征相当。 结论：接受CAR-T治疗的TiNHL患者结局优于dnDLBCL患者，且安全性相近，支持将CAR-T作为TiNHL的标准治疗。
BACKGROUND: Transformed indolent non-Hodgkin lymphoma (TiNHL) generally has poorer outcomes than de novo diffuse large B-cell lymphoma (dnDLBCL). Although anti-CD19 CAR T-cell therapy is standard for relapsed/refractory (R/R) large B-cell lymphoma (LBCL), its prognostic role across histologies remains unclear. METHODS: We conducted a multicenter, retrospective/prospective observational study comparing R/R TiNHL and R/R dnDLBCL patients treated with commercial CAR T-cell therapy and enrolled in the Italian CART-SIE study. FINDINGS: Among 438 patients, 107 had TiNHL (96 transformed follicular lymphoma [tFL], 11 transformed marginal zone lymphoma [tMZL]) and 331 had dnDLBCL. Baseline characteristics were comparable. TiNHL patients showed superior overall (83% vs 69%) and complete response rates (62% vs 53%) (both p < 0 01), with better 2-year progression-free survival (PFS: 44% vs 31%) and overall survival (OS: 61% vs 48%) (both p < 0 01). CAR-HEMATOTOX score predicted worse outcomes (PFS HR=2 10; OS HR=3 57). No significant differences were found between tFL and tMZL. Two-year relapse/progression incidence was lower in TiNHL (28% vs 47%, p < 0 01), with similar non-relapse mortality (11% vs 4%, p = 0 12). Safety profiles, including cytokine release syndrome and ICANS rates, were comparable. CONCLUSION: TiNHL patients receiving CAR T-cell therapy achieved better outcomes than dnDLBCL patients, with comparable safety, supporting its use as a standard treatment in TiNHL.
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