Most patients with large cell lymphoma are cured with frontline chemoimmunotherapy. For individuals with refractory disease and those who relapse after conventional therapies, chimeric antigen receptor (CAR) T cells are an important treatment option and have led to remissions in otherwise refractory patients. In the pivotal trials, durable responses were achieved in approximately 40% to 50% of patients treated with axicabtagene ciloleucel, tisagenlecleucel, or lisocabtagene maraleucel, indicating that many patients will require subsequent treatment. Failure after CAR T cell therapy is caused by a variety of factors that can be divided into 3 broad categories: tumor intrinsic factors, other host factors, and inadequacies of the CAR T cells. Within this framework, this article reviews possible mechanisms of treatment failures and, based on the timing of relapse, considers potential salvage therapies and opportunities for future clinical studies.

中文翻译：

---

嵌合抗原受体T细胞治疗后理解和管理大B细胞淋巴瘤复发。

大多数大细胞淋巴瘤患者可通过一线化学免疫疗法治愈。对于患有难治性疾病的患者以及常规治疗后复发的患者，嵌合抗原受体（CAR）T细胞是一种重要的治疗选择，可导致原本难治的患者缓解。在关键试验中，大约40％至50％的接受阿昔单抗基因环丙沙星，替沙可根微核素或可瑞可卡培因maraleucel治疗的患者获得了持久的反应，表明许多患者将需要后续治疗。CAR T细胞治疗后的失败是由多种因素引起的，这些因素可分为3大类：肿瘤内在因素，其他宿主因素和CAR T细胞的不足。在此框架内，本文回顾了治疗失败的可能机制，