帕博利珠单抗治疗 axicabtagene ciloleucel 治疗失败后的缓解：病例报告及文献复习。
Pembrolizumab-induced Remission After Failure of Axicabtagene Ciloleucel: Case Report and Literature Review.
机构信息
First Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece;
First Internal Medicine Department, Propaedeutic, Hematology Clinical Trial Unit, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
出版信息
In Vivo. 2021 Nov-Dec;35(6):3401-3406. doi: 10.21873/invivo.12639.
BACKGROUND
Failure after CD19-directed chimeric antigen receptor (CAR) T-cell therapy for patients with large B-cell B non-Hodgkin lymphoma, especially when it happens early, is an emerging clinical problem. There are no specific recommendations and therefore treatment of these patients remains empiricaI. Immune checkpoint inhibitors are becoming a therapeutic option for these patients.
CASE REPORT
We present a case of a primary mediastinal large B-cell lymphoma who experienced relapse 3.5 months after axicabtagene-ciloleucel therapy and received pembrolizumab. After four cycles of pembrolizumab, complete metabolic response was confirmed. Treatment was discontinued after the sixth cycle due to immune checkpoint inhibitor-related pneumonitis. The disease remains in remission 8 months after the last pembrolizumab dose. We propose mechanisms of action and optimal duration of pembrolizumab treatment in this setting. Finally, we review the existing literature on the sequential administration of CD19-directed CAR T-cell therapy and immune checkpoint inhibitors.
CONCLUSION
Immune checkpoint inhibitors are a promising treatment option for patients after failure of CD19-directed CAR-T cell therapy.
背景
对于患有大 B 细胞非霍奇金淋巴瘤的患者，尤其是在 CAR-T 细胞治疗后早期发生失败的情况下，CD19 定向嵌合抗原受体（CAR）T 细胞治疗后失败是一个新出现的临床问题。目前尚无具体建议，因此这些患者的治疗仍然是经验性的。免疫检查点抑制剂正在成为这些患者的治疗选择。
病例报告
我们报告了一例原发性纵隔大 B 细胞淋巴瘤患者，在 axicabtagene-ciloleucel 治疗后 3.5 个月复发，并接受了 pembrolizumab 治疗。在接受了四个周期的 pembrolizumab 治疗后，确认了完全代谢缓解。由于免疫检查点抑制剂相关的肺炎，在第六个周期后停止了治疗。在最后一次 pembrolizumab 剂量后 8 个月，疾病仍处于缓解状态。我们提出了在这种情况下 pembrolizumab 治疗的作用机制和最佳持续时间。最后，我们回顾了关于 CD19 定向 CAR-T 细胞治疗和免疫检查点抑制剂序贯给药的现有文献。
结论
免疫检查点抑制剂是 CD19 定向 CAR-T 细胞治疗失败后患者的一种有前途的治疗选择。
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