摘要
嵌合抗原受体（CAR）修饰的T细胞（CAR－T）免疫治疗，在近几年国内外针对难治/复发急性B淋巴细胞白血病（B－ALL）/B细胞淋巴瘤临床研究中疗效惊人，已有两项CAR－T产品经美国FDA批准正式进入临床应用。然而，临床研究也发现CAR－T治疗缓解后，患者总复发率可高达50%以上，其中约20%以上是CAR－T靶向CD分子的阴性复发。靶向分子甚至是原发肿瘤基因异常阴性复发率增加，提示肿瘤细胞在CAR－T高精度靶向治疗压力下，免疫逃逸甚至克隆演变事件发生率迅速上升。监测微小残留病（MRD）以评估疗效、早期发现复发趋势及时指导进一步临床干预，仍是CAR－T治疗时代B－ALL诊断治疗不可或缺的重要辅助手段。而CAR－T治疗后疾病复发的新特点对传统和新兴的MRD检测手段提出了更高的要求，需要进行重新评估和改良以确保CAR－T治疗时代，MRD检测手段依然能够精准有效的评估疗效，监测复发。
Chimeric antigen receptor modified T cell （CAR-T） immunotherapy has achieved remarkable success in the treatment of hematological malignancies, especially for relapsed/refractory acute B lymphocytic leukemia （B-ALL） leukemia patients, most of whom could obtain complete remissions or partial remissions. However, clinical studies also found a as high as 50% total recurrence rate of these patients, in which more than 20% patients relapsed with tumor cells not expressing the primary CAR-T-targeted CD molecules. Increased relapses with negative targeted-molecules or even lost primary abnormal tumor gene, suggesting that immune escape and even clonal evolution events increased rapidly under the high-precision CAR-T immunotherapy pressure. Monitoring of minimal residual disease （MRD） is important to assess the efficacy and find recurrence trends early in a timely manner to guide further clinical intervention. The new features of disease recurrence after CAR-T treatment have put forward higher requirements for traditional and emerging MRD detection methods so as to ensure their effectiveness in the CAR-T treatment era.（Chin J Lab Med, 2018, 41： 175-179）
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2018年第3期175-179,共5页
Chinese Journal of Laboratory Medicine
基金
上海市科学技术委员会医学引导类（西医）科技支撑项目（16411970900）
国家自然科学基金（81470322）
关键词
嵌合抗原受体修饰的T细胞
白血病
微小残留病
Chimeric antigen receptor modified T cell
Leukemia
Minimal residual disease
