■复发/难治性B细胞急性淋巴细胞白血病(r/rB-ALL)代表儿科癌症,具有挑战性的预后。CAR-T细胞治疗,被认为是一种先进的治疗方法,由于高复发率和不良事件仍存在争议.这项研究评估了CART细胞治疗r/rB-ALL的有效性和安全性。
■在四个数据库上进行文献检索。疗效参数包括微小残留病阴性完全缓解(MRD-CR)和复发率(RR)。安全性参数构成细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS)。
■抗CD22显示出优异的疗效,MRD-CR事件发生率最高,RR最低,与抗CD19相比。将CAR-T细胞疗法与单倍体相合干细胞移植相结合可改善RR。安全方面,双特异性抗CD19/22的CRS率最低,抗CD22显示的ICANS最少。共刺激受体的分析表明,向抗CD19CART细胞添加CD28ζ在减少复发方面表现出优异的功效,具有良好的安全性。
选择更有效、更安全的CAR-T细胞治疗对于提高急性白血病患者的总体生存率至关重要。除了有前途的抗CD22CART细胞,探索共刺激结构域和新的CD靶点可以提高r/rB-ALL的治疗效果。
UNASSIGNED: Relapse/refractory B-cell acute lymphoblastic leukaemia (r/r B-ALL) represents paediatric cancer with a challenging prognosis. CAR T-cell treatment, considered an advanced treatment, remains controversial due to high relapse rates and adverse events. This study assessed the efficacy and safety of CAR T-cell therapy for r/r B-ALL.
UNASSIGNED: The literature search was performed on four databases. Efficacy parameters included minimal residual disease negative complete remission (MRD-CR) and relapse rate (RR). Safety parameters constituted cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).
UNASSIGNED: Anti-CD22 showed superior efficacy with the highest MRD-CR event rate and lowest RR, compared to anti-CD19. Combining CAR T-cell therapy with haploidentical stem cell transplantation improved RR. Safety-wise, bispecific anti-CD19/22 had the lowest CRS rate, and anti-CD22 showed the fewest ICANS. Analysis of the costimulatory receptors showed that adding CD28ζ to anti-CD19 CAR T-cell demonstrated superior efficacy in reducing relapses with favorable safety profiles.
UNASSIGNED: Choosing a more efficacious and safer CAR T-cell treatment is crucial for improving overall survival in acute leukaemia. Beyond the promising anti-CD22 CAR T-cell, exploring costimulatory domains and new CD targets could enhance treatment effectiveness for r/r B-ALL.