北京大学肿瘤医院嵌合抗原受体T细胞治疗淋巴瘤全流程管理原则

The whole process management principles of chimeric antigen receptor T-cell therapy for lymphoma at Peking University Cancer Hospital

嵌合抗原受体T(CAR-T)细胞在血液肿瘤尤其是淋巴瘤中取得了优异疗效,全球范围内已经有多个产品获批上市,我国也有两个靶向CD19靶点的产品获批用于治疗复发难治大B细胞淋巴瘤。目前使用CAR-T细胞的经验均来自于既往临床研究,如何规范、合理应用CAR-T细胞仍是临床医生面临的问题。基于北京大学肿瘤医院淋巴肿瘤内科的CAR-T细胞应用经验,并结合目前国内外相关研究进展,从患者筛选、外周血单个核细胞采集、桥接治疗、淋巴细胞清除化疗、CAR-T细胞回输、回输后患者监测及不良反应处理、回输后长期随访等多个环节进行详细总结,旨在指导临床医生更好地应用CAR-T细胞,为患者带来最大获益。

Chimeric antigen receptor T(CAR-T)cell has achieved excellent efficacy in hematological tumors,especially for lymphoma.Many products have been approved to market all over the world,and 2 products targeting CD19 have been approved to treat relapsed and refractory large B-cell lymphoma in China.The current experiences of using CAR-T cells come from previous clinical studies.How to use CAR-T cells in a standardized and rationalized way is still a challenge faced by our clinicians.Based on the CAR-T cell treatment experiences from Peking University Cancer Hospital and the latest research progresses in CAR-T in China and abroad,this article will elaborate on patient screening,peripheral blood mononuclear cell collection,bridging treatment,lymphocyte depletion chemotherapy,CAR-T cell infusion,the monitoring and treatment of adverse events after infusion,and long-term follow-up after infusion,in order to guide clinicians to better use CAR-T cell and to bring maximum benefits to patients.