Approximately 65% of patients with diffuse large B-cell lymphoma are cured with first-line therapy. However, approximately 10% to 15% exhibit primary refractory disease, and 20% to 25% experience relapse after initial response. Eligible patients receive second-line therapy followed by high-dose chemotherapy and an autologous hematopoietic stem cell transplant, previously the only potentially curative option for this population. Recently approved chimeric antigen receptor (CAR) T-cell therapies offer an alternative curative option for patients who have experienced a second-line or later relapse or whose disease is refractory. CD19-targeting CAR T cells are autologous T cells expressing an anti-CD19 CAR that, when reintroduced to the patient, identify and kill CD19⁺ B cells. Because of the novelty of CAR T-cell therapy and the complexity of this patient population, identification of ideal candidates is still being defined. This article summarizes 3 patient cases, focusing on the important aspects of patient selection for CAR T-cell therapy.

一线治疗可治愈约65％的弥漫性大B细胞淋巴瘤患者。但是，约有10％至15％的患者表现出原发性难治性疾病，而20％至25％的患者在最初反应后会复发。符合条件的患者接受二线治疗，然后进行大剂量化学治疗和自体造血干细胞移植，以前是该人群的唯一可能治愈的选择。最近批准的嵌合抗原受体（CAR）T细胞疗法为经历二线或更晚复发或疾病难治的患者提供了另一种治疗选择。靶向CD19的CAR T细胞是表达抗CD19 CAR的自体T细胞，当将其重新引入患者时，它可以识别并杀死CD19 ⁺B细胞。由于CAR T细胞疗法的新颖性和该患者群体的复杂性，理想的候选者的鉴定仍在确定中。本文总结了3例患者案例，重点介绍了CAR T细胞疗法患者选择的重要方面。