CAR-T(CAR-T)细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CAR-T(CAR-T)细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Efficacy and Safety of Lisocabtagene Maraleucel in Relapsed or Refractory Large B-Cell Lymphoma: A Product-Specific Systematic Review and Meta-Analysis of Clinical Trials and Real-World Studies.
Efficacy and Safety of Lisocabtagene Maraleucel in Relapsed or Refractory Large B-Cell Lymphoma: A Product-Specific Systematic Review and Meta-Analysis of Clinical Trials and Real-World Studies.
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Liso-cel 单药治疗在 R/R LBCL 的临床试验和真实世界环境中均显示出较高的汇总缓解率和较低的严重 CRS 及 ICANS 汇总发生率。严重 ICANS 虽不常见,但仍具有临床意义,而严重血液学毒性较常见,需要密切监测和支持治疗。这些发现为 liso-cel 在 R/R LBCL 中的应用提供了产品特异性基准。
Lisocabtagene maraleucel (liso-cel) 是一种靶向 CD19 的CAR-T 细胞 疗法,已获批用于复发/难治性大 B 细胞淋巴瘤 (R/R LBCL)。然而,大多数已发表的关于 CAR-T 疗法治疗 LBCL 的 meta 分析汇总了不同产品的数据,限制了针对特定产品的解读。
我们开展了一项系统综述和meta分析,纳入评估liso-cel单药治疗R/R LBCL的临床试验和回顾性真实世界研究。主要终点为总缓解率(ORR)。次要终点包括完全缓解(CR)、3级不良事件发生率,包括细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS)、总死亡率(OMR)、疾病进展相关死亡率和不良事件相关死亡率。采用随机效应模型估计合并比例。
共纳入11项研究、1206例患者,包括5项临床试验和6项真实世界回顾性队列。汇总ORR为78%,汇总CR率为60%。汇总OMR为38%,疾病进展相关死亡率为28%,不良事件相关死亡率为4%。重度(3级)CRS和ICANS的发生率分别为2%和8%。重度(3级)血液学毒性常见,尤其是中性粒细胞减少、血小板减少和贫血。
We conducted a systematic review and meta-analysis of clinical trials and retrospective real-world studies evaluating liso-cel monotherapy in R/R LBCL. The primary endpoint was the overall response rate (ORR). Secondary endpoints included complete response (CR), incidence of grade 3 adverse events, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), overall mortality rate (OMR), disease progression-related mortality, and adverse event-related mortality. Pooled proportions were estimated using random-effects models.
Eleven studies including 1206 patients were analyzed, comprising five clinical trials and six real-world retrospective cohorts. The pooled ORR was 78%, and the pooled CR rate was 60%. The pooled OMR was 38%, with a disease progression-related mortality of 28% and an adverse event-related mortality of 4%. Severe (grade 3) CRS and ICANS occurred in 2% and 8%, respectively. Severe (grade 3) hematologic toxicities were frequent, particularly neutropenia, thrombocytopenia, and anemia.
Liso-cel monotherapy demonstrated high pooled response rates and low pooled incidences of severe CRS and ICANS across clinical trials and real-world settings in R/R LBCL. Severe ICANS, although uncommon, remains clinically meaningful, and severe hematologic toxicities were frequent and warrant careful monitoring and supportive care. These findings provide product-specific benchmarks for liso-cel in R/R LBCL.
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