Current state-of-the-art of immunotherapy in follicular lymphoma.

IF 2.3 4区医学 Q2 HEMATOLOGY

Expert Review of Hematology Pub Date : 2025-06-19 DOI:10.1080/17474086.2025.2522956

Sean McKeague, Phil Thompson, John F Seymour

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引用次数: 0

Abstract

Introduction: The advent of immunotherapy has rapidly changed the treatment landscape of follicular lymphoma (FL).

Areas covered: Autologous CD19 chimeric antigen receptor T- cell (CAR-T) products show unprecedented efficacy in 3^rd line FL but substantial rates of cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Bispecific antibodies (BSAB) achieve deep and durable responses in heavily pretreated FL patients with less severe CRS and minimal neurological toxicity. BSAB have differing routes of administration, treatment duration and CRS prophylaxis. Checkpoint inhibitors show disappointing response rates in FL. Lenalidomide and tazametostat have modest single agent activity in FL, but synergize with other forms of immunotherapy.

Expert opinion: CAR-T offers a short duration of therapy with a potential plateau in progression free survival. Major disadvantages include cost, availability, requirement for lymphodepletion and toxicity. BSAB are available 'off the shelf,' have a comparably lower toxicity profile and are ripe for combination. With both platforms, there are significant infectious risks. There are unanswered questions regarding when to use immunotherapy for FL, impact of disease burden, role of re-treatment and optimal sequencing/combinations. Moving forward, the field will need to develop new prognostic markers, reassess treatment indications and focus on minimizing toxicity.

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滤泡性淋巴瘤免疫治疗的最新进展。

免疫疗法的出现迅速改变了滤泡性淋巴瘤（FL）的治疗前景。涉及领域：自体CD19嵌合抗原受体T细胞（CAR-T）产品在三线FL中显示出前所未有的疗效，但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）的发生率很高。双特异性抗体（BSAB）在重度预处理的FL患者中获得深度和持久的应答，CRS较轻，神经毒性最小。BSAB有不同的给药途径、治疗时间和CRS预防。来那度胺和他他他司他在滤泡性淋巴细胞中有适度的单药活性，但与其他形式的免疫治疗协同作用。专家意见：CAR-T治疗时间短，无进展生存期可能达到平台期。主要缺点包括成本、可获得性、需要淋巴细胞清除和毒性。BSAB是现成的，具有相对较低的毒性，并且适合组合使用。这两个平台都存在重大的感染风险。关于何时使用免疫治疗FL，疾病负担的影响，再治疗的作用和最佳测序/组合，还有一些未解决的问题。展望未来，该领域将需要开发新的预后标志物，重新评估治疗适应症，并将重点放在最小化毒性上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Hematology HEMATOLOGY-

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.