How to Combine the Two Landmark Treatment Methods-Allogeneic Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Together to Cure High-Risk B Cell Acute Lymphoblastic Leukemia?
How to Combine the Two Landmark Treatment Methods-Allogeneic Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy Together to Cure High-Risk B Cell Acute Lymphoblastic Leukemia?
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如何结合异基因造血干细胞移植和嵌合抗原受体T细胞治疗这两种标志性治疗方法来治愈高危B细胞急性淋巴细胞白血病？
DOI：
10.3389/fimmu.2020.611710
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发表时间：
2020
影响因子：
7.3
通讯作者：
Huang H
中科院分区：
文献类型：
--
作者：
Zhang M;Huang H
同种异体造血干细胞移植（allogene hematopoietic stem cell transplantation，简称alloo - hsct）在过去几十年里取得了巨大的进展，并在世界范围内得到越来越多的应用。单倍体造血干细胞移植的成功使得“每个人都有一个捐赠者”成为可能。在缓解期接受移植的患者可能有良好的结果，而在疾病晚期接受移植的患者预后较差。尽管嵌合抗原受体T （CAR-T）细胞疗法目前是复发或难治性（R/R） B细胞急性淋巴细胞白血病（B- all）免疫治疗的一个里程碑，并且在先前接受多种治疗的患者中显示出高缓解率，但相对较高的复发率仍然是CAR-T细胞疗法成为一种优秀治疗选择的障碍。因此，结合这两种方法（alloo - hsct和CAR-T细胞治疗）是一个有吸引力的研究领域，以进一步改善R/R B-ALL的预后。在这篇综述中，我们将根据现有数据讨论当前的临床实践，包括CAR-T细胞作为治疗R/R B-ALL的桥梁，以及CAR-T细胞输注治疗移植后复发。我们将进一步探索结合这两种方法的其他可能的方法，包括CAR- t细胞疗法清除移植周围的微小残留疾病，结合CAR技术治疗移植物抗宿主病，以及CAR- t细胞作为同种异体造血移植的一部分的潜力。
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has made tremendous progress in the last few decades and is increasingly being used worldwide. The success of haploidentical HSCT has made it possible to have “a donor for everyone”. Patients who received transplantation in remission may have a favorable outcome, while those who were transplanted in advanced stages of disease have a poor prognosis. Although chimeric antigen receptor T (CAR-T) cell therapy is currently a milestone in the immunotherapy of relapsed or refractory (R/R) B cell acute lymphoblastic leukemia (B-ALL) and has demonstrated high remission rates in patients previously treated in multiple lines, the relatively high relapse rate remains a barrier to CAR-T cell therapy becoming an excellent cure option. Therefore, combining these two approaches (allo-HSCT and CAR-T cell therapy) is an attractive area of research to further improve the prognosis of R/R B-ALL. In this review, we will discuss the current clinical practices of combining allo-HSCT with CAR-T cell therapy based on available data, including CAR-T cells as a bridge to allo-HSCT for R/R B-ALL and CAR-T cell infusion for post-transplant relapse. We will further explore not only other possible ways to combine the two approaches, including CAR-T cell therapy to clear minimal residual disease peri-transplantation and incorporation of CAR technology to treat graft-versus-host disease, but also the potential of CAR-T cells as a part of allo-HSCT.
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