复发/难治性弥漫大B细胞淋巴瘤患者的治疗新进展

New advance in treatment of patients with relapsed/refractory diffuse large B-cell lymphoma

30%~40%的弥漫大B细胞淋巴瘤(DLBCL)患者可进展为复发/难治性(relapsed/refractory,R/R)DLBCL,其治疗困难,治愈机会有限。新型抗体药物偶联物(ADC)、单克隆抗体、双特异性抗体(BsAb)和嵌合抗原受体T细胞(CAR-T)免疫疗法等治疗药物和方法的不断涌现,使R/R DLBCL患者的疗效和预后有所改善。然而,R/R DLBCL患者的不利生物学特征、次优治疗选择,以及耐药性和不良事件的发生均使其治疗面对巨大挑战。因此,更深入地探讨新型药物和治疗方法对R/R DLBCL生物学特征改变的影响,对提高患者生存及改善预后至关重要。笔者拟从单克隆抗体、BsAb、ADC、免疫疗法、靶向细胞凋亡途径药物、Bruton酪氨酸激酶抑制剂(BTKi)及靶向表观遗传学调节因子药物等方面,对R/R DLBCL患者的治疗新进展进行阐述,旨在为R/R DLBCL患者制订个性化治疗方案提供参考,以进一步提高疗效和改善预后。

30%to 40%of patients with diffuse large B-cell lymphoma(DLBCL)can progress to relapsed/refractory(R/R)DLBCL,which is difficult to treat and has limited chance of cure.New drugs and therapies such as antibody drug conjugate(ADC),monoclonal antibody,bispecific antibody(BsAb)and chimeric antigen receptor-T cell(CAR-T)are emerging,which could improve the outcomes and prognosis of R/R DLBCL patients.However,the unfavorable biological characteristics,suboptimal treatment options,occurrence of drug resistance and adverse events in R/R DLBCL still make its treatment a great challenge.Therefore,a better understanding of how novel drugs and therapeutic approaches affect R/R DLBCL biological alterations is critical.This article proposes to elaborate new advances in the treatment of R/R DLBCL in terms of monoclonal antibodies,BsAb,ADC,immunotherapy,drugs targeting apoptosis pathways,Bruton tyrosine kinase inhibitor(BTKi)and drugs targeting epigenetic modulators,aiming to develop personalized treatment regimens for R/R DLBCL patients in the future,and to further enhance efficacy and improve prognosis.