CAR-T细胞治疗的神经毒性副反应处理新策略

New strategies for the treatment of neurotoxic side effects in CAR-T cell therapy

嵌合型抗原受体修饰T (chimeric antigen receptor modified T,CAR-T)细胞疗法是肿瘤免疫治疗的重要手段之一,CAR-T细胞的靶向性、杀伤活性、增殖性和持久性较常规T细胞明显提高,并且经过不断的改进演变,其在血液系统肿瘤治疗中取得了巨大的成效,受到广泛的关注。然而,其治疗过程中出现的神经毒性,也称CAR-T细胞相关脑病综合征(CAR-T cell relevant encephalopathy syndrome,CRES),影响了CAR-T疗法的临床应用。探索CRES的发病机制及其高风险因素、寻找相应的处理策略,对预防和治疗CRES具有重要意义。本文以CD19-CAR-T 细胞治疗为例,就CRES的发病症状、发病机制、高风险因素及应对策略作一综述,为临床治疗提供参考。

Chimeric antigen receptor modified T (CAR-T) cell therapy is one of the important methods of tumor immunotherapy. The targeting, killing, proliferation and persistence of CAR-T cells are significantly enhanced than that of conventional T cells. After continuous improvement and evolution, CAR-T cell treatment has achieved excellent progress in hematological tumors and has received extensive attention. However, neurotoxicity arising from the treatment, also known as CAR-T cell relevant encephalopathy syndrome (CRES), has affected its clinical application. Exploring the pathogenesis of CRES and high-risk factors, and finding appropriate strategies is therefore critical for the prevention and treatment of CRES. Here, we take CD19-CAR-T cell treatment as example to review the symptoms and pathogenesis of CRES, discuss high-risk factors as well as coping strategies, in an effort to provide a reference for clinical treatment.