CD19 CAR-T Cell Therapy for Relapsed or Refractory Nodal and Gastrointestinal Follicular Lymphoma: Current Advances and Future Perspectives.

IF 4.1 Q1 Medicine

Current Gastroenterology Reports Pub Date : 2025-12-04 DOI:10.1007/s11894-025-01028-9

Takuya Watanabe

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引用次数: 0

Abstract

Purpose of review: Follicular lymphoma (FL) is the most common indolent B-cell lymphoma, yet primary gastrointestinal FL (GI-FL) remains poorly defined, and treatment of relapsed/refractory cases is controversial. This review aims to critically evaluate the role of CD19-directed chimeric antigen receptor (CAR) T-cell therapy in nodal and GI-FL, highlighting key clinical trials and the unique biological considerations of GI involvement.

Recent findings: Pivotal trials such as ZUMA-5, ELARA, and TRANSCEND FL have demonstrated high overall and complete response rates with durable progression-free survival in patients with relapsed/refractory FL. Liso-cel in particular has shown a favourable efficacy-toxicity balance, including in patients with transformed disease or progression within 24 months (POD24). However, data specific to GI-FL are scarce, and emerging evidence suggests that its microenvironment, immune checkpoint expression, and mutational profile may influence CAR-T responses differently from nodal FL. CD19 CAR-T therapy represents a major therapeutic advance for relapsed/refractory FL and holds promise for patients with advanced or high-risk GI-FL. Nonetheless, the rarity of GI-FL, limited dedicated clinical data, and challenges such as treatment-related toxicities, costs, and accessibility warrant further prospective studies. Integrating biomarker-based patient selection and GI-FL-specific trial designs will be crucial to optimise the application of CAR-T therapy in this distinct subtype.

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CD19 CAR-T细胞治疗复发或难治性淋巴结和胃肠道滤泡性淋巴瘤：当前进展和未来展望

回顾目的：滤泡性淋巴瘤（滤泡性淋巴瘤）是最常见的惰性b细胞淋巴瘤，但原发性胃肠道滤泡性淋巴瘤（GI-FL）的定义尚不明确，复发/难治性病例的治疗也存在争议。本综述旨在批判性地评估cd19靶向嵌合抗原受体（CAR） t细胞治疗在淋巴结和GI- fl中的作用，强调关键的临床试验和GI受损伤的独特生物学考虑。最近的发现：关键试验，如ZUMA-5、ELARA和TRANSCEND FL，在复发/难治性FL患者中显示出高的总体和完全缓解率和持久的无进展生存期。特别是Liso-cel，包括在24个月内疾病转化或进展的患者（POD24）中，显示出良好的疗效-毒性平衡。然而，GI-FL的特异性数据很少，新出现的证据表明，其微环境、免疫检查点表达和突变谱可能对CAR-T反应的影响不同于淋巴结性FL。CD19 CAR-T治疗代表了复发/难治性FL的主要治疗进展，并为晚期或高风险GI-FL患者带来了希望。然而，GI-FL的罕见性、有限的专用临床数据以及治疗相关的毒性、成本和可及性等挑战需要进一步的前瞻性研究。整合基于生物标志物的患者选择和gi - fl特异性试验设计对于优化CAR-T治疗在这一独特亚型中的应用至关重要。

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

Current Gastroenterology Reports Medicine-Gastroenterology

CiteScore

7.80

自引率

0.00%

发文量

期刊介绍： As the field of gastroenterology and hepatology rapidly evolves, the wealth of published literature can be overwhelming. The aim of the journal is to help readers stay abreast of such advances by offering authoritative, systematic reviews by leading experts. We accomplish this aim by appointing Section Editors who invite international experts to contribute review articles that highlight recent developments and important papers published in the past year. Major topics in gastroenterology are covered, including pediatric gastroenterology, neuromuscular disorders, infections, nutrition, and inflammatory bowel disease. These reviews provide clear, insightful summaries of expert perspectives relevant to clinical practice. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.