嵌合抗原受体
医学
抗原
免疫学
CD19
细胞疗法
造血干细胞移植
T细胞
肿瘤科
干细胞
内科学
移植
生物
免疫系统
遗传学
作者
Adam J. Lamble,Amy Moskop,Michael A. Pulsipher,Shannon L. Maude,Corinne Summers,Colleen Annesley,André Baruchel,Lia Gore,Persis Amrolia,Nirali N. Shah
标识
DOI:10.1016/j.jtct.2023.08.030
摘要
Although CD19-directed chimeric antigen receptor (CAR) T cell therapy (CAR-T) for relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL) has been transformative in inducing and sustaining remission, relapse rates remain unacceptably high, with approximately 50% of children and young adults experiencing relapse within the first year postinfusion. Emerging strategies to extend the durability of remission involve the use of prognostic biomarkers to identify those at high risk of relapse or incorporate strategies aimed to enhancing functional CAR T cell persistence. Nonetheless, with antigen loss/down-regulation or evolution to lineage switch as major mechanisms of relapse, optimizing single antigen targeting alone is insufficient. Here, with a focus on relapse prevention strategies, including postinfusion surveillance and treatment approaches being explored to optimize post-CAR-T management (eg, combinatorial antigen targeting strategies, preemptive hematopoietic cell transplantation), we review the current state of the art in the prevention and management of post CAR-T relapse. We highlight the advancements in the field and identify gaps in the literature to guide future research in optimizing the prevention and management of post-CAR-T relapse in children and young adults with B-ALL.
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