侵袭性淋巴瘤进展迅速，容易复发，现有的治疗仍未能获得令人满意的治愈率。尤其是高危患者群体，对精准、高效治疗的需求更为迫切。第12届美国血液肿瘤学会年会（SOHO 2024）于2024年9月4日至7日在美国休斯顿隆重举办，吸引了全球血液肿瘤领域的顶尖专家，在此交流最新的研究成果，共同探讨治疗的新策略。在会议期间，《肿瘤瞭望-血液时讯》有幸采访了阿根廷Pavlovsky血液学中心的Astrid Pavlovsk教授，请她深入分析了侵袭性淋巴瘤治疗中新型疗法的疗效、安全性和应用现状，并特别关注了患者个体差异等关键议题，为临床实践带来启发。
《肿瘤瞭望-血液时讯》关于新型疗法在侵袭性淋巴瘤治疗中的长期效果和安全性，目前有哪些数据支持？
Astrid Pavlovsk教授：对于各种最新的治疗策略，目前我们正在进行随访，时间长短不同。我们在CAR-T细胞疗法治疗淋巴瘤中进行的最长随访结果显示，约有20%的患者可治愈，三年总生存率约为40%。这表明确实有患者从CAR-T细胞疗法中得到治愈。然而，这仍需要更长时间的随访来观察这些患者是否真的被治愈。我们有数据平台正在进行更详细随访数据的收集和分析。
Oncology Frontier-Hematology Frontier：What data currently supports the long-term efficacy and safety of novel therapies in the treatment of aggressive lymphoma?
Dr. Astrid Pavlovsk：We have different follow-up on the newest treatment strategies. The longest follow-up of CAR-T cell in lymphoma showing there is a curability of about 20% of the patients with an overall survival at 3 years of about 40% of the patients. This is the longest survival. I think we do have patients that get cured from that therapy. Regarding my specifics in diffuse B cell lymphoma. There is a plateau showing that we need further follow-up to see if these patients are actually cured from the disease.
《肿瘤瞭望-血液时讯》侵袭性淋巴瘤的新型疗法在临床上的应用现状如何？存在哪些限制因素？
Astrid Pavlovsk教授：这取决于患者的居住地点和经济资源，以及他们所在的国家的诊疗中心情况。对于部分患者，包括CAR-T细胞疗法、临床研究、双特异性抗体等最新治疗资源的可及性较高。而其他很多地区的患者仍接受化疗、自体造血干细胞移植、甚至可能有异基因造血干细胞移植。正如西班牙的数据显示，这些因素对整体生存有显著影响。全世界的可及性情况差异很大。
Oncology Frontier-Hematology Frontier：What is the current status of novel therapies for aggressive lymphoma in clinical practice? And what are the limiting factors?
Dr. Astrid Pavlovsk：The limiting factors are very variable, depending on where the patient lives, the economical resources, the countries where they have the center, where they are being treated. Some patients can easily have access to CAR-T, to clinical trials, to bispecifics and to novel agencies. Many patients around the world are still treated with chemotherapy and autologous stem cell transplantation and maybe other genetics transplantation. As the Spanish data showed, this has an impact on overall survival. So access is very diverse around the world.
《肿瘤瞭望-血液时讯》在侵袭性淋巴瘤的新型疗法中，如何考虑和应对患者的个体差异？
Astrid Pavlovsk教授：我认为最大的个体差异在于复发的时间和次数。对于那些早期复发或原发难治的患者，经历的治疗线数越多，疗效越差。经2线治疗与经5线治疗的结局是不一样的。因此，我认为既往治疗的线数和复发的时间应是最重要的考虑因素。
Oncology Frontier-Hematology Frontier：How are individual difference among patients considered and addressed in novel therapies?
Dr. Astrid Pavlovsk：I think the biggest difference comes into the time of relapse. For those patients that have early relapse or primary refractory disease, these treatments are less effective. For patients who have more lines of therapy, it's not the same to have novel therapy after 2 lines of therapy as it is to have it after 5 lines of therapy. So I think time to relapse and the number of lines of treatment you have received are the most important factors.
《肿瘤瞭望-血液时讯》为了提高新型疗法的可及性，您认为临床医生能做些什么？
Astrid Pavlovsk教授：我认为首先是开展更多的临床研究。在中低收入国家，CAR-T细胞治疗对于患者来说过于昂贵，可及性很低。因此，如果能将这些患者纳入临床研究，将增加他们可能的治疗机会。此外，在世界各地，这些药物的价格不应该相同，不发达国家的负担能力与发达国家不同，发达国家CAR-T细胞疗法的价格对于不发达国家而言是难以负担的。
Oncology Frontier-Hematology Frontier：What do you think the clinicians can do to improve the accessibility of novel therapies?
Dr. Astrid Pavlovsk：Clinical trials. I think in countries with low and middle income patients have no access to this very expensive therapy. So at least we can include patients into clinical trials. And our patients could have an opportunity. And hopefully the price for these drugs should not be the same all around the world. There are countries that can definitely not afford these prices.