肿瘤细胞治疗研究
英文原题：Efficacy-safety trade-off and patient selection: a meta-analysis informing clinical choice between CAR-T and bispecific antibodies for R/R B-NHL.
这些结果提供了一个全面的、基于证据的框架，用于指导临床实践中的个体化治疗和序贯治疗。
本meta分析比较了CAR-T 细胞疗法与双特异性抗体（BsAbs）治疗复发/难治性B细胞非霍奇金淋巴瘤（R/R B-NHL）的疗效与安全性。我们分析了59项I/II期试验，共纳入2,914例患者。CAR-T的ORR（72% [95% CI 67-77%] vs. 50% [38-62%]）和CR（54% [49-59%] vs. 33% [23-46%]）均高于BsAbs。然而，其与更高的3级CRS（8% [6-11%] vs. 4% [3-7%]）、ICANS（12% [9-16%] vs. 6% [2-18%]）和神经毒性（8% [6-10%] vs. 6% [2-13%]）发生率相关。在CAR-T构建体中，双靶点产品（CD19/20和CD19/22）显示出更高的疗效，但毒性特征更为多样；在BsAbs中，CD3 CD20相较于CD3 CD19具有更有利的安全性特征。这些结果提示，当深度缓解为首要目标时，CAR-T可能更优；而对于体弱患者或希望接受门诊治疗且毒性风险较低的患者，BsAbs可能更合适。治疗选择应根据患者特征进行个体化制定，包括年龄、肿瘤负荷和合并症。总之，这些结果为临床实践中的个体化治疗和序贯治疗提供了全面的循证框架。
This meta-analysis compared chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAbs) for relapsed/refractory B-cell non-Hodgkin lymphoma (R/R B-NHL), focusing on efficacy and safety. We analyzed 59 phase I/II trials involving 2,914 patients. CAR-T achieved higher ORR (72% [95% CI 67-77%] vs. 50% [38-62%]) and CR (54% [49-59%] vs. 33% [23-46%]) than BsAbs. However, it was associated with higher rates of grade 3 CRS (8% [6-11%] vs. 4% [3-7%]), ICANS (12% [9-16%] vs. 6% [2-18%]), and neurotoxicity (8% [6-10%] vs. 6% [2-13%]). Among CAR-T constructs, dual-targeting products (CD19/20 and CD19/22) showed higher efficacy with more varied toxicity profiles; among BsAbs, CD3 CD20 had a more favorable safety profile relative to CD3 CD19. These results suggest CAR-T may be preferable when deep remission is the priority, whereas BsAbs could be a better fit for frail patients or those seeking outpatient care with lower toxicity risks. Treatment selection should be tailored to patient characteristics, including age, tumor burden, and comorbidities. Together, these results provide a comprehensive, evidence-based framework to guide individualized treatment and sequencing in clinical practice.
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