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:Hypo-fractionated radiotherapy combined with PD-1 inhibitor for relapsed/refractory B-cell lymphoma after failure to CD19 CAR-T therapy.
Hypo-fractionated radiotherapy combined with PD-1 inhibitor for relapsed/refractory B-cell lymphoma after failure to CD19 CAR-T therapy.
CAR-T治疗近7年后,患者出现疾病复发,并被诊断为滤泡性淋巴瘤(FL)。
B细胞淋巴瘤在嵌合抗原受体(CAR)T细胞治疗后复发缺乏有效的标准治疗选择,且通常预后较差,这在很大程度上归因于免疫逃逸和肿瘤异质性等机制。放疗联合免疫检查点抑制剂(ICIs)可能产生协同效应,包括通过辐射诱导的DNA损伤实现局部肿瘤控制,以及通过调节肿瘤免疫微环境实现全身免疫激活。本病例报告描述了一例复发/难治性(R/R)B细胞淋巴瘤患者,该患者经历了多次复发和治疗失败,包括CD19 CAR-T治疗。在CAR-T治疗近7年后,患者出现疾病复发,并被诊断为滤泡性淋巴瘤(FL)。患者接受了低分割放疗(30 Gy/5次)与程序性死亡-1(PD-1)抑制剂卡瑞利珠单抗联合的个体化治疗策略,实现了完全缓解(CR),并保持无病状态超过43个月。本病例凸显了该联合策略在R/R淋巴瘤中的潜在疗效,尤其是在治疗选择有限的患者中。
B-cell lymphoma relapsed after chimeric antigen receptor (CAR) T-cell therapy lacks effective standard treatment options and generally has a poor prognosis, largely due to mechanisms such as immune escape and tumor heterogeneity. Radiotherapy combined with immune checkpoint inhibitors (ICIs) may exert synergistic effects, including local tumor control through radiation-induced DNA damage and systemic immune activation via modulation of the tumor immune microenvironment. This case report describes a patient with relapsed/refractory (R/R) B-cell lymphoma who experienced multiple relapses and treatment failures, including CD19 CAR-T therapy. Almost 7 years after CAR-T treatment, the patient developed disease relapse and was diagnosed with follicular lymphoma (FL). The patient received a personalized treatment strategy combining hypo-fractionated radiotherapy (30 Gy/5 fractions) and the Programmed Death-1 (PD-1) inhibitor camrelizumab, achieving complete remission (CR) and remaining disease-free for over 43 months. This case highlights the potential efficacy of this combination strategy in R/R lymphoma, particularly in patients with limited treatment options.
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