While the mainstay of treatment for high-risk or relapsed, refractory leukemia has historically revolved around allogeneic hematopoietic stem cell transplant (allo-HSCT), targeted immunotherapies have emerged as a promising therapeutic option, especially given the poor prognosis of patients who relapse after allo-HSCT. Novel cellular immunotherapies that harness the cytotoxic abilities of the immune system in a targeted manner (often called “adoptive” cell therapy), have changed the way we treat r/r hematologic malignancies and continue to change the treatment landscape given the rapid evolution of these powerful, yet sophisticated precision therapies that often offer a less toxic alternative to conventional salvage therapies. Importantly, adoptive cell therapy can be allo-HSCT-enabling or a therapeutic option for patients in whom transplantation has failed or is contraindicated. A solid understanding of the core concepts of adoptive cell therapy is necessary for stem cell transplant physicians, nurses and ancillary staff given its proximity to the transplant field as well as its inherent complexities that require specific expertise in compliant manufacturing, clinical application, and risk mitigation. Here we will review use of targeted cellular therapy for the treatment of r/r leukemia, focusing on chimeric antigen receptor T-cells (CAR T-cells) given the remarkable sustained clinical responses leading to commercial approval for several hematologic indications including leukemia, with brief discussion of other promising investigational cellular immunotherapies and special considerations for sustainability and scalability.

虽然高风险或复发难治性白血病的主要治疗方法历来都是围绕同种异体造血干细胞移植 (allo-HSCT)，但靶向免疫疗法已成为一种有前途的治疗选择，特别是考虑到异体造血干细胞移植后复发的患者预后不良。 -造血干细胞移植。以有针对性的方式利用免疫系统的细胞毒性能力的新型细胞免疫疗法（通常称为“过继性”细胞疗法）已经改变了我们治疗难治性血液恶性肿瘤的方式，并且鉴于这些疾病的快速发展，将继续改变治疗格局。强大而复杂的精准疗法通常为传统挽救疗法提供毒性较小的替代方案。重要的是，过继细胞疗法可以支持同种异体造血干细胞移植，或者是移植失败或禁忌的患者的治疗选择。干细胞移植医生、护士和辅助人员有必要充分了解过继细胞疗法的核心概念，因为它靠近移植领域，而且其固有的复杂性需要合规制造、临床应用和风险缓解方面的特定专业知识。 。在这里，我们将回顾靶向细胞疗法在治疗 r/r 白血病中的应用，重点关注嵌合抗原受体 T 细胞（CAR T 细胞），因为其显着的持续临床反应导致包括白血病在内的多种血液学适应症获得商业批准，简要讨论其他有前途的研究性细胞免疫疗法以及对可持续性和可扩展性的特殊考虑。