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从预测到干预:人工智能用于血液系统恶性肿瘤细胞治疗中的适应性反应与毒性建模

英文原题:From Prediction to Intervention: Artificial Intelligence for Adaptive Response and Toxicity Modeling in Cellular Therapies for Hematologic Malignancies.

PubMed 2026/08/12(内容时间) Cancers (Basel) Q2 · IF 4.8(JCR 2025)

研究概要

血液系统恶性肿瘤,包括急性髓系白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤,其特征是显著的生物学异质性和高度动态的治疗轨迹,而传统的静态预后系统无法完全捕捉这些特征。

中文摘要

血液系统恶性肿瘤,包括急性髓系白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤,其特征是深刻的生物学异质性和高度动态的治疗轨迹,传统的静态预后系统无法完全捕捉。细胞疗法,如CAR-T 细胞疗法和造血干细胞移植,为复发或难治性疾病提供了潜在治愈的选择,但结局仍高度可变,而关于预处理强度、淋巴细胞清除、免疫抑制和毒性监测的管理决策在很大程度上仍由方案驱动,而非个体化调整。人工智能(AI)和机器学习(ML)在血液系统恶性肿瘤的诊断支持、预后分层和多模态数据整合方面已展现出巨大前景,但现有模型仍以静态为主,且定位多局限于治疗前,限制了其在实时临床指导中的实用性。本综述总结了 AI 在血液肿瘤学中的当前应用;批判性地比较了主要 AI 模型类别的优势、局限性和临床适用性,包括传统机器学习、深度学习、多模态整合框架、强化学习、数字孪生以及新兴的基础模型和大语言模型;并提出了一种自适应、多模态的范式。我们审视了关键的使能技术,并讨论了在这些系统能够部署于床旁之前必须解决的临床、监管、伦理和实施方面的挑战。我们认为,该领域面临的核心挑战已不再是 AI 能否预测结局,而是它能否主动指导实时治疗决策,而实现这一转变将需要跨学科合作、前瞻性验证,以及能够确保可解释性、公平性和临床可信度的治理框架。

展开英文摘要原文

Hematologic malignancies, including acute myeloid leukemia, myelodysplastic syndromes, lymphoma, and multiple myeloma, are characterized by profound biological heterogeneity and highly dynamic treatment trajectories that conventional, static prognostic systems incompletely capture. Cellular therapies, such as chimeric antigen receptor T-cell therapy and hematopoietic stem cell transplantation, offer potentially curative options for relapsed or refractory disease, yet outcomes remain highly variable, and management decisions regarding conditioning intensity, lymphodepletion, immunosuppression, and toxicity surveillance continue to be largely protocol-driven rather than individually adapted. Artificial intelligence (AI) and machine learning (ML) have demonstrated substantial promise in diagnostic support, prognostic stratification, and multimodal data integration across hematologic malignancies, but existing models remain predominantly static and related to pre-treatment in orientation, limiting their utility for real-time clinical guidance. This review summarizes current AI applications in hematologic oncology; critically compares the strengths, limitations, and clinical applicability of major AI model classes, including traditional machine learning, deep learning, multimodal integrative frameworks, reinforcement learning, digital twins, and emerging foundation models and large language models; and proposes an adaptive, multimodal paradigm. We examine key enabling technologies and address the clinical, regulatory, ethical, and implementation challenges that must be resolved before these systems can be deployed at the bedside. We argue that the central challenge facing the field is no longer whether AI can predict outcomes, but whether it can actively guide real-time therapeutic decisions, and that achieving this transition will require interdisciplinary collaboration, prospective validation, and governance frameworks capable of ensuring interpretability, equity, and clinical trustworthiness.

论文信息

作者
Amoozgar B、Bangolo A、Thor DC、Rajanna S、Abdelwahab S、Mohamed AS、Mansour C、Ehsanullah SU
第一作者单位
Department of Bone Marrow Transplant and Cellular Therapy, Loma Linda University Health, Loma Linda, CA 92350, USA.United States
通讯作者单位
Department of Hematology Oncology, University Medical Center, El Paso, TX 79905, USA.United States
文献类型
综述
期刊
Cancers2026 Aug 12
原文标识
PubMed 42649912 · DOI 10.3390/cancers18162598