摘要
Multiple myeloma(MM),considered an incurable hematological malignancy,is characterized by its clonal evolution of malignant plasma cells.Although the application of autologous stem cell transplantation(ASCT)and the introduction of novel agents such as immunomodulatory drugs(IMiDs)and proteasome inhibitors(PIs)have doubled the median overall survival to eight years,relapsed and refractory diseases are still frequent events in the course of MM.To achieve a durable and deep remission,immunotherapy modalities have been developed for relapsed/refractory multiple myeloma(RRMM).Among these approaches,chimeric antigen receptor(CAR)T-cell therapy is the most promising star,based on the results of previous success in B-cell neoplasms.In this immunotherapy,autologous T cells are engineered to express an artificial receptor which targets a tumor-associated antigen and initiates the T-cell killing procedure.Tisagenlecleucel and Axicabtagene,targeting the CD19 antigen,are the two pacesetters of CAR T-cell products.They were approved by the US Food and Drug Administration(FDA)in 2017 for the treatment of acute lymphocytic leukemia(ALL)and diffuse large B-cell lymphoma(DLBCL).Their development enabled unparalleled efficacy in combating hematopoietic neoplasms.In this review article,we summarize six promising candidate antigens in MM that can be targeted by CARs and discuss some noteworthy studies of the safety profile of current CAR T-cell therapy.
多发性骨髓瘤被认为是一种无法治愈的血液系统恶性疾病,其特征为恶性浆细胞的克隆性增殖。尽管在过去的几十年中,自体干细胞移植(ASCT)的应用及新型药物(蛋白酶体抑制剂和免疫调节药)的问世,将患者的中位生存时间由原来的4年提高到了8年,但复发与难治仍然是多发性骨髓瘤疾病进程中难以逾越的鸿沟。为了获得长期持续的缓解,免疫治疗开始在多发性骨髓瘤中崭露头角,其中嵌合抗原受体(CAR)T细胞治疗就是最有潜力的一颗新星。通过在基因层面改造患者自己的T细胞,使T细胞表达一种特定的受体(人造的融合蛋白),该受体可以识别并结合肿瘤相关抗原,并活化T细胞启动后续的杀伤过程。Tisagenlecleucel和Axicabtagene是两个针对CD19抗原的CAR T产品,用于治疗B细胞来源的急性淋巴细胞白血病(B-ALL)和弥漫大B细胞淋巴瘤(DLBCL),并于2017年被美国食品药品监督管理局(FDA)批准。这两个产品的发展极大推动了B细胞来源的恶性血液系统疾病的治疗,并刷新了对于传统治疗的认知。基于之前CAR T治疗的成功经验,寻找如CD19一样的特定靶点能为CAR T治疗多发性骨髓瘤打下基础。本综述介绍了数个在骨髓瘤细胞上的肿瘤靶抗原,如B细胞成熟抗原(BCMA)和CD38。这些针对抗原的CAR T治疗有些还在实验室阶段,而有些已经进入了3期的临床试验,很有可能成为下一个被批准的CAR T产品。另外,本综述也介绍了在CAR T治疗中出现的毒副反应以及相应的管理和处理方法。
