CAR T 细胞血液毒性的新见解:表现、机制和有效管理策略。

IF 9.4 1区 医学 Q1 HEMATOLOGY
Yuanyuan Yang, Hongwei Peng, Jianxiang Wang, Fei Li
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引用次数: 0

摘要

嵌合抗原受体(CAR)T 细胞疗法是一种高效的治疗方式,已被证明可提高恶性肿瘤患者的治疗效果,尤其是那些复发或难治性血液恶性肿瘤患者。然而,CAR T 细胞疗法的应用不断升级,但也出现了一些危及生命的毒性反应,特别是细胞因子释放综合征(CRS)、免疫效应细胞相关神经毒性综合征(ICANS)、感染和血液学毒性反应(HTs),从而阻碍了 CAR T 细胞疗法的广泛应用。血液毒性包括一系列不良反应,包括细胞减少症、嗜血细胞淋巴组织细胞增多症(HLH)、凝血功能障碍和 B 细胞再生障碍。虽然我们对 CRS 和 ICANS 潜在机制的理解在不断进步,但 HTs 复杂的病理生理学仍未得到充分阐明。这些知识空白可能会导致治疗决策失当,最终可能导致大量医疗资源耗竭并损害患者的生活质量。在这篇综合综述中,我们根据最近的最新研究结果,描述了导致 CAR T 细胞疗法后 HTs 的各种机制,解释了 HTs 的表现形式,并提出了战略性干预措施,以缓解这一相关的临床挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
New insights into CAR T-cell hematological toxicities: manifestations, mechanisms, and effective management strategies.

Chimeric antigen receptor (CAR) T-cell therapy represents a highly efficacious treatment modality demonstrated to enhance outcomes in patients afflicted with malignancies, particularly those enduring relapsed or refractory hematological malignancies. However, the escalating adoption of CAR T-cell therapy has unveiled several life-threatening toxicities, notably cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), infections, and hematological toxicities (HTs), thereby hindering the broad implementation of CAR T-cell therapy. HTs encompass a spectrum of adverse effects, including cytopenias, hemophagocytic lymphohistiocytosis (HLH), coagulopathies, and B-cell aplasia. While our comprehension of the underlying mechanisms governing CRS and ICANS is advancing, the intricate pathophysiology of HTs remains inadequately elucidated. Such knowledge gaps may precipitate suboptimal therapeutic decisions, potentially culminating in substantial medical resource depletion and detriment to patients' quality of life. In this comprehensive review, based on recent updated findings, we delineate various mechanisms contributing to HTs subsequent to CAR T-cell therapy, explicate manifestations of HTs, and proffer strategic interventions to mitigate this relevant clinical challenge.

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来源期刊
CiteScore
12.60
自引率
7.30%
发文量
97
审稿时长
6 weeks
期刊介绍: Experimental Hematology & Oncology is an open access journal that encompasses all aspects of hematology and oncology with an emphasis on preclinical, basic, patient-oriented and translational research. The journal acts as an international platform for sharing laboratory findings in these areas and makes a deliberate effort to publish clinical trials with 'negative' results and basic science studies with provocative findings. Experimental Hematology & Oncology publishes original work, hypothesis, commentaries and timely reviews. With open access and rapid turnaround time from submission to publication, the journal strives to be a hub for disseminating new knowledge and discussing controversial topics for both basic scientists and busy clinicians in the closely related fields of hematology and oncology.
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