Experts' consensus on the management of CAR-T therapy in the context of SARS-CoV-2 infection (2024 version)
马军 1张文宏 2郎华 张俊伟
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作者信息
1. 哈尔滨血液病肿瘤研究所，哈尔滨 150010
2. 复旦大学附属华山医院感染科，上海 200040
折叠
摘要
嵌合抗原受体T细胞（CAR-T）疗法作为恶性肿瘤治疗领域的焦点之一，在血液系统恶性肿瘤尤其是淋巴瘤的临床实践中表现出良好疗效和安全性。实际应用中，由于CAR-T的生产工艺复杂、接受治疗的患者存在个体差异，在治疗期间需实时监测并按需调整方案。新型冠状病毒的暴发流行对CAR-T治疗提出了更大的挑战。新型冠状病毒普遍易感、传播迅速，且潜伏期长短不等，可能损害免疫系统功能。血液系统恶性肿瘤患者经历多线治疗后可出现T细胞功能受损、免疫功能下降等，若同时感染新型冠状病毒，则可能诱发更严重的并发症。CAR-T治疗的特殊要求、新型冠状病毒感染的疾病特点及患者的极易感性给临床带来了多重挑战。文章基于国内外指南共识、权威文献及国内该领域相关专家临床诊疗经验，针对新型冠状病毒感染背景下CAR-T治疗全流程的临床应用及注意事项给予建议，供临床医生和专业诊疗机构参考。 Chimeric antigen receptor T cell (CAR-T) therapy, as one of the focuses in the field of malignant tumor treatment, has shown favorable efficacy and safety in patients with hematological malignancies, particularly in lymphoma. In clinical practice, due to the intricate manufacturing process of CAR-T product and individualized differences among the patients, it is necessary to monitor in real-time and adjust the regimens during the treatment based on the patients' needs. The SARS-CoV-2 is characterized with high susceptibility, rapid spread and short or wide incubation period, which may impair the function of the immune system and has added a greater challenge for CAR-T therapy in malignancies. Patients with hematological malignancies receiving multiple lines of treatment are normally observed with impaired T cell function and weakened immune function. This may induce more severe complications to those vulnerable patients if they experienced SARS-CoV-2 infection. Therefore, the special requirements of CAR-T therapy, the disease characteristics of SARS-CoV-2 infection and the heightened susceptibility of the patients have brought several challenges in clinic. The consensus is developed based on domestic and international guidelines, consensus and authoritative literature in recent years, as well as the practical experiences from various clinical professionals and experts in China. The aim of the consensus is to provide references and suggestions regarding the clinical application and the whole management process of CAR-T therapy in the context of SARS-CoV-2 infection for clinicians and professional institutions.
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy, as one of the focuses in the field of malignant tumor treatment, has shown favorable efficacy and safety in patients with hematological malignancies, particularly in lymphoma. In clinical practice, due to the intricate manufacturing process of CAR-T product and individualized differences among the patients, it is necessary to monitor in real-time and adjust the regimens during the treatment based on the patients' needs. The SARS-CoV-2 is characterized with high susceptibility, rapid spread and short or wide incubation period, which may impair the function of the immune system and has added a greater challenge for CAR-T therapy in malignancies. Patients with hematological malignancies receiving multiple lines of treatment are normally observed with impaired T cell function and weakened immune function. This may induce more severe complications to those vulnerable patients if they experienced SARS-CoV-2 infection. Therefore, the special requirements of CAR-T therapy, the disease characteristics of SARS-CoV-2 infection and the heightened susceptibility of the patients have brought several challenges in clinic. The consensus is developed based on domestic and international guidelines, consensus and authoritative literature in recent years, as well as the practical experiences from various clinical professionals and experts in China. The aim of the consensus is to provide references and suggestions regarding the clinical application and the whole management process of CAR-T therapy in the context of SARS-CoV-2 infection for clinicians and professional institutions.
关键词
新型冠状病毒感染/嵌合抗原受体T细胞/淋巴瘤,非霍奇金
Key words
SARS-CoV-2 infection/Chimeric antigen receptor T cell/Lymphoma, non-Hodgkin
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