天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (12): 1330-1335.doi: 10.11958/20180819

• 循证医学 • 上一篇    下一篇

Car-T治疗B细胞淋巴瘤疗效研究的Meta分析

张锡友，李丹丹，陈峰，宋清坤，钟晓松   

  1. 1首都医科大学附属北京世纪坛医院血液内科（邮编100038），2神经肿瘤综合治疗病区，3科技处，4临床基因与细胞工程中心
  • 收稿日期:2018-05-23 修回日期:2018-09-02 出版日期:2018-12-15 发布日期:2019-01-24
  • 通讯作者: 张锡友 E-mail:1127407012@qq.com

The efficacy of chimeric antigen receptor T-cell immunotherapy in B-cell lymphoma: Meta-analysis

ZHANG Xi-you,LI Dan-dan,CHEN Feng,SONG Qing-kun,ZHONG Xiao-song   

  1. 1 Department of Hematology, 2 Department of Comprehensive Treatment of Neuro-oncology, 3 Technology Department, 4 Clinical Cell and Gene Engineering Center Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2018-05-23 Revised:2018-09-02 Published:2018-12-15 Online:2019-01-24

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摘要： 目的 探讨嵌合抗原受体T细胞（Car-T）治疗B细胞淋巴瘤疗效及其影响因素，为更加合理、高效地应用Car-T治疗提供理论依据。方法 检索Pubmed数据库和The Cochrane library数据库的英文文献，共筛选出从建库至2018年1月为止公开发表的Car-T治疗B细胞淋巴瘤的11篇文献。以反应率作为结局指标，按照患者的年龄、病理类型、目标抗原、共刺激分子、预处理方案等因素的不同进行亚组分析，采用Meta分析汇总反应率。结果 Car-T治疗B细胞淋巴瘤的总反应率为75%（95%CI：0.67~0.84）。亚组分析各因素合并反应率：年龄＜65岁组80%（95%CI： 0.73~0.87），年龄≥65岁组88%（95%CI：0.78~0.98）；病理类型弥漫性大B细胞淋巴瘤组81%（95%CI：0.74~0.87）；非弥漫性大B细胞淋巴瘤组79%（95%CI：0.68~0.89），目标抗原CD19组77%（95%CI：0.68~0.87），非CD19组69%（95%CI：0.47~0.91），共刺激分子CD28组78%（95%CI：0.71~0.84），非CD28组73%（95%CI：0.62~0.84），预处理方案Cy/Flu组78%（95%CI：0.72~0.84），非Cy/Flu组69%（95%CI：0.50~0.88）。结论 Car-T对B细胞淋巴瘤具有较高的反应率。年龄在65岁以上、病理类型DLBCL、目标抗原CD19、共刺激分子CD28、预处理方案Cy/Flu（环磷酰胺+氟达拉滨）均有较高的反应率。

关键词: 淋巴瘤, B细胞, 治疗结果, Meta分析, 嵌合抗原受体T细胞, 反应率

Abstract: Objective To investigate the efficacy of chimeric antigen receptor T-cell (Car-T) in the treatment of Bcell lymphoma, and provide a theoretical basis for more rational and efficient application of Car-T therapy. Methods English literature from Pubmed database and the Cochrane library database were comprehensively retrieved. A quantitative and comprehensive analysis was conducted for eleven literatures regarding Car-T in the treatment of B-cell lymphoma that were published from the establishment of database to January 2018. The response rate was used as the indicator of outcome.The subgroup analysis was performed according to the age, pathological type, target antigen, costimulatory molecule and conditioning chemotherapy. Meta-analysis was used to summary the response rate. Results The total response rate of CarT in the treatment of B cell lymphoma was 75% (95%CI: 0.67-0.84). The combined response rates of the factors were 80%(age＜65 group, 95%CI: 0.73-0.87), 88% (age≥65 group, 95%CI: 0.78-0.98), 81% (diffuse large B-cell lymphoma group,95%CI: 0.74-0.87), 79% (non diffuse large B-cell lymphoma group, 95%CI: 0.68-0.89), 77% (CD19 target antigen group,95%CI: 0.68-0.87), 69% (non CD19 target antigen group, 95%CI: 0.47-0.91), 78% (CD28 costimulatory molecule group,95%CI: 0.71-0.84), 73% (non CD28 costimulatory molecule group, 95%CI: 0.62-0.84), 78% (Cy / Flu conditioning chemotherapy group, 95%CI: 0.72-0.84), and 69% (non Cy / Flu conditioning chemotherapy group, 95%CI: 0.50-0.88)respectively. Conclusion Car-T has a high response rate on B-cell lymphoma. Subgroup analysis shows that the quite high response rates are achieved in patients with over 65 years of age, pathological type diffuse large B-cell lymphoma, target antigen CD19, costimulatory molecule CD28 and conditioning chemotherapy Cy/Flu (cyclophosphamide +fludarabine).

Key words: lymphoma, B-cell, treatment outcome, Meta-analysis, chimeric antigen receptor T cell, response rate