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异基因嵌合抗原受体T细胞(CAR-T)桥接至异基因造血干细胞移植(allo-HSCT)作为难治性成人伯基特淋巴瘤的一种治疗策略:一例病例报告

Allogeneic CAR-T bridging to allo-HSCT as a treatment strategy for refractory adult Burkitt's lymphoma: a case report.

作者信息

Cheng Ling, Huang Mei, Cao Yang, Wang Jue, Xu Hao, Jiang Lijun

机构信息

Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Transl Cancer Res. 2022 Aug;11(8):2996-3002. doi: 10.21037/tcr-22-174.

Abstract

BACKGROUND

Epstein-Barr-virus-negative Burkitt's lymphoma (BL) is highly aggressive, and it is extremely rare that the lesion is confined to the uterine cervix at the time of diagnosis. Primary BL of the cervix lacks standardization of management due to its rarity. Autologous chimeric-antigen-receptor-T (CAR-T) cell therapy has achieved favourable outcomes in B cell malignant tumors, but the effect on BL is not satisfactory. With the continuous development of new technologies, allogeneic CAR-T cell therapy is constantly optimized, becoming safer and more effective, and it may become the first-line treatment option for malignant tumor cases with poor prognosis and insufficient treatment approaches.

CASE DESCRIPTION

A middle-aged Chinese female patient was admitted to the hospital for unexplained vaginal bleeding and cervical mass, and was diagnosed as primary BL of the cervix through pathological examination. After the failure of multi-line chemotherapy, the patient received donor-derived CD19/CD22 dual-targeted CAR-T cell therapy and achieved partial remission before bridging to allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, our patient eventually died of complications associated with allo-HSCT and septic shock before neutrophil and platelet implantation.

CONCLUSIONS

The current results have confirmed that allogeneic CAR-T cells could provide better treatment opportunities for more patients. To our knowledge, this is the first report of allogeneic CAR-T cell therapy bridging to allo-HSCT in the treatment of primary BL of the cervix. And it provides a more treatment options for refractory adult BL.

摘要

背景

爱泼斯坦-巴尔病毒阴性的伯基特淋巴瘤(BL)具有高度侵袭性,诊断时病变局限于子宫颈极为罕见。宫颈原发性BL由于罕见,缺乏标准化的治疗方案。自体嵌合抗原受体T(CAR-T)细胞疗法在B细胞恶性肿瘤中取得了良好疗效,但对BL的效果并不令人满意。随着新技术的不断发展,同种异体CAR-T细胞疗法不断优化,变得更安全、更有效,可能成为预后不良且治疗方法不足的恶性肿瘤病例的一线治疗选择。

病例描述

一名中国中年女性患者因不明原因的阴道出血和宫颈肿物入院,经病理检查诊断为宫颈原发性BL。多线化疗失败后,患者接受了供体来源的CD19/CD22双靶点CAR-T细胞疗法,并在桥接至异基因造血干细胞移植(allo-HSCT)前实现部分缓解。不幸的是,我们的患者最终在中性粒细胞和血小板植入前死于与allo-HSCT相关的并发症和感染性休克。

结论

目前的结果证实,同种异体CAR-T细胞可为更多患者提供更好的治疗机会。据我们所知,这是首例同种异体CAR-T细胞疗法桥接allo-HSCT治疗宫颈原发性BL的报告。它为难治性成人BL提供了更多的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6cae/9459576/df0e34596323/tcr-11-08-2996-f1.jpg

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