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:Multifunctional CD38 in the pathogenesis and treatment of B-cell lymphomas.
B细胞淋巴瘤是一组高度异质性的非霍奇金淋巴瘤。
B细胞淋巴瘤是一组具有高度异质性的非霍奇金淋巴瘤。尽管治疗手段不断进步,B细胞淋巴瘤的临床结局仍有待改善。CD38是一种跨膜多功能蛋白,广泛表达于多种B细胞淋巴瘤亚型。研究表明,CD38在B细胞淋巴瘤中发挥多种致病作用,包括调控增殖、凋亡和免疫调节,主要通过其酶活性以及对恶性淋巴瘤细胞和免疫抑制细胞信号通路的影响来实现,使其成为有价值的治疗靶点。近年来,针对CD38的治疗策略,如抗CD38抗体和CD38导向的CAR-T细胞疗法,已在B细胞淋巴瘤中进行探索。本综述总结了CD38分子功能的相关知识、CD38在B细胞淋巴瘤(从惰性到侵袭性亚型)中异质性表达及预后作用的数据、抗CD38抗体的疗效及作用机制、目前对治疗耐药机制的理解、CD38靶向治疗的前沿进展,以及新型靶向和免疫治疗在临床应用中的挑战,从而力求深入理解CD38在B细胞淋巴瘤发病机制和治疗中的作用。CD38靶向治疗尤其有望成为CD20阴性淋巴瘤的一种新型可选治疗方法,因为此类淋巴瘤尚未建立标准治疗方案。尽管在既往临床试验中抗CD38抗体在大多数其他B细胞淋巴瘤中的疗效较低,与daratumumab在多发性骨髓瘤中的显著疗效形成对比,但正在进行的临床试验中的新型治疗策略和联合治疗有可能克服拮抗作用,并改善复发/难治性B细胞淋巴瘤患者的临床结局。
B-cell lymphoma is a group of non-Hodgkin lymphomas with high heterogeneity. Despite advancement in therapeutics, the clinical outcomes of B-cell lymphomas need to be improved. CD38, a transmembrane multifunctional protein, is widely expressed across various B-cell lymphoma subtypes. Research indicates that CD38 plays multiple pathogenic roles in B-cell lymphomas, including regulation of proliferation, apoptosis, immune modulation, primarily through its enzymatic activity and its influence on signaling pathways in malignant lymphoma cells and immunosuppressive cells, making it a valuable therapeutic target. In recent years, CD38-targeted therapies, such as anti-CD38 antibodies and CD38-directed CAR-T cell therapies, have been explored for B-cell lymphomas. This review summarizes the knowledge on CD38 molecular functions, data of CD38 heterogeneous expression and prognostic role in B-cell lymphomas (from indolent to aggressive subtypes), anti-CD38 antibody efficacy and mechanisms of action, current understanding of the treatment resistance mechanisms, frontier advances in CD38-targeted therapies, and the challenges of novel targeted and immunotherapies in clinical applications, thereby seeking to provide a deep understanding of the role of CD38 in the pathogenesis and treatment of B-cell lymphomas. CD38-targed therapy is especially promising as a novel and optional treatment for CD20-negative lymphomas, for which standard treatment has not been established. Although the efficacy of anti-CD38 antibodies in most other B-cell lymphomas is low in previous clinical trials, in contrast to the remarkable efficacy of daratumumab in multiple myeloma, novel therapeutic strategies and combination therapies in ongoing clinical trials have the potential to overcome the counteracting actions and to improve the clinical outcomes of patients with relapsed/refractory B-cell lymphoma.
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