The 2024 Chinese Expert Consensus on Immunotherapy for Lymphoma, developed by the Committee on Tumor Immunotherapy of the Chinese Geriatric Health Association, summarizes the application and research progress of immunotherapies in lymphoma, including monoclonal antibodies, bispecific antibodies, immune checkpoint inhibitors, antibody-drug conjugates (ADCs), immunomodulators, and cellular therapies. Key highlights are as follows:
Monoclonal Antibodies
- Rituximab
- Indications: Primarily for CD20-positive non-Hodgkin lymphomas (NHL), including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and marginal zone lymphoma (MZL).
- Examples:
- R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, prednisone) is the standard first-line regimen for DLBCL.
- Adding rituximab (alone or with chemotherapy) to radiotherapy improves failure-free survival (FFS) and progression-free survival (PFS) in stage I–II FL.
- Obinutuzumab
- Indications:
- First-line therapy for stage II (with bulky disease), III, or IV FL in adults, combined with chemotherapy.
- Maintenance therapy for patients achieving ≥PR.
- Second-line option for symptomatic stage III/IV MZL (e.g., obinutuzumab + bendamustine/lenalidomide).
- Indications:
- Zanubrutinib
- Indications: Combined with standard CHOP chemotherapy for CD20-positive DLBCL (not otherwise specified) in adults.
Bispecific Antibodies
- Glofitamab
- Mechanism: Binds CD20 and CD3, activating T cells to eliminate CD20-positive lymphoma cells.
- Indications: Relapsed/refractory (R/R) DLBCL.
- Mosunetuzumab
- Efficacy: Shows promising responses in B-cell lymphomas, even in heavily pretreated patients.
- Epcoritamab
- Features: Unique mechanism with favorable safety; demonstrates efficacy in refractory lymphomas in clinical trials.
Immune Checkpoint Inhibitors
- PD-1 Inhibitors (e.g., pembrolizumab, nivolumab)
- Mechanism: Block PD-1/PD-L1 interaction to restore T-cell antitumor activity.
- Indications: Classical Hodgkin lymphoma (cHL), primary mediastinal large B-cell lymphoma (PMBCL).
- PD-L1 Inhibitors (e.g., atezolizumab)
- Application: Effective in select lymphoma subtypes; usage depends on tumor biology and patient profile.
Antibody-Drug Conjugates (ADCs)
- Brentuximab Vedotin (BV)
- Target: CD30.
- Indications: CD30-positive cHL and anaplastic large cell lymphoma (ALCL); delivers MMAE (cytotoxic agent) selectively to tumor cells.
- Polatuzumab Vedotin (Pola)
- Target: CD79b.
- Role: Critical for R/R DLBCL and other B-cell malignancies.
- Loncastuximab Tesirine (Lonca)
- Target: CD19.
- Potential: Emerging option for R/R B-cell lymphomas.
Cellular Therapies
- CD19 CAR-T Cell Therapy
- Mechanism: Autologous T cells engineered to express CD19-targeting chimeric antigen receptors (CARs).
- Efficacy: Achieves durable remission in R/R B-cell lymphomas (e.g., DLBCL, FL, MCL).
- Dual-Target CAR-T
- Advantage: Targets two antigens to reduce tumor escape; shows promise in clinical trials.
- Combination Strategies
- CAR-T + PD-1 inhibitors: Enhances antitumor immunity.
- CAR-T + chemotherapy: Reduces tumor burden pre-CAR-T infusion to improve efficacy.
Share this content:
Leave a Reply