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CD19靶向CAR-T治疗复发/难治性弥漫大B细胞淋巴瘤疗效和安全性的Meta分析
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| 篇名： | CD19靶向CAR-T治疗复发/难治性弥漫大B细胞淋巴瘤疗效和安全性的Meta分析 |
| TITLE： | Efficacy and safety of CD 19-targeted CAR-T therapy for relapsed/refractory diffuse large B-cell lymphoma：a meta-analysis |
| 摘要： | 目的 探讨CD19靶向嵌合抗原受体T细胞（CAR-T）治疗复发/难治性弥漫大B细胞淋巴瘤（R/RDLBCL）的疗效及其不良反应，为更加合理、高效地应用CAR-T提供循证依据。方法检索PubMed、Embase、Cochrane、ClinicalTrials.gov、中国知网、万方数据库、维普网并筛选从建库至2022年4月公开发表的CD19靶向CAR-T治疗R/RDLBCL的文献。以客观缓解率（ORR）、完全缓解率（CRR）和不良反应发生率作为结局指标，根据CAR-T细胞共刺激因子及研究类型的不同进行亚组分析，采用R4.1.2软件进行Meta分析、敏感性分析和发表偏倚分析。结果共筛选出11篇文献，共计1466名患者。CD19靶向CAR-T细胞治疗R/RDLBCL的ORR为72.1%（95%CI：62.3%～81.9%），CRR为50.8%（95%CI：41.1%～60.5%），细胞因子释放综合征（CRS）发生率为77.5%（95%CI：65.6%～89.4%），神经毒性发生率为41.4%（95%CI：26.8%～56.1%）。亚组分析结果显示：共刺激因子CD28亚组患者的ORR、CRR、CRS发生率及神经毒性发生率均高于4-1BB亚组，观察性试验亚组患者的ORR、CRR、CRS发生率及神经毒性发生率均高于干预性试验亚组。结论CD19靶向CAR-T治疗R/RDLBCL具有较高的ORR、CRR，同时也具有较高的不良反应发生率。共刺激因子CD28亚组患者与4-1BB亚组相比，有更高的ORR、CRR、CRS发生率和神经毒性发生率。 |
| ABSTRACT： | OBJECTIVE To investigate the efficacy and adverse reaction of CD 19-targeted chimeric antigen receptor T cells （CAR-T）in the treatment of relapsed/refractory diffuse large B -cell lymphoma （R/R DLBCL ），so as to provide an evidence -based basis for more reasonable and efficient application of CAR -T. METHODS Retrieved from PubMed ，Embase，Cochrane， ClinicalTrials.gov，CNKI，Wanfang，VIP database ，the literature about CD 19 targeted CAR -T in the treatment of R/R DLBCL that were published from the inception to April 2022 were screened . Taking objective remission rate （ORR），complete remission rate （CRR）and incidence of adverse reactions as outcome indicators ，subgroup analysis was performed according to the costimulatory factor of CAR -T and the different types of research . R 4.1.2 software was used for meta -analysis，sensitivity analysis and publication bias analysis . RESULTS A total of 11 pieces of literature were screened ，involving 1 466 patients. The ORR of CD -19 targeted CAR -T cells in the treatment of R/R DLBCL was 72.1%（95% CI：62.3%-81.9%），the CRR was 50.8%（95% CI：41.1%- 60.5%），the incidence of cytokine release syndrome （CRS）was 77.5%（95% CI：65.6%-89.4%），the incidence of neurotoxicity was 41.4%（95% CI：26.8%-56.1%）. Results of subgroup analysis showed that the incidence of ORR ，CRR，CRS and neurotoxicity in costimulatory factor CD 28 subgroup were higher than those in 4-1BB subgroup . The incidence of ORR ，CRR，CRS and neurotoxicity in the observational experimental subgroup were higher than those in the intervention experimental subgroup . CONCLUSIONS CD19 targeted CAR -T has high ORR and CRR for R/R DLBCL ，as well as higher incidence of adverse reactions. Co-stimulatory factor CD 28 has higher ORR ，CRR， CRS incidence and neurotoxicity incidence than 4-1BB. |
| 期刊： | 2022年第33卷第21期 |
| 作者： | 李碧云，韩亚辉，殷楚云，王颖超 |
| AUTHORS： | LI Biyun ，HAN Yahui ，YIN Chuyun ，WANG Yingchao |
| 关键字： | 弥漫大B细胞淋巴瘤；CD19；复发/难治性；嵌合抗原受体T细胞；Meta分析 |
| KEYWORDS： | diffuse large B -cell lymphoma ； CD19； |
| 阅读数： | 214 次 |
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