CD19 导向的自体嵌合抗原受体 T 细胞 (CAR-T) 疗法改变了复发/难治性 (R/R) 大 B 细胞淋巴瘤 (LBCL) 的治疗。 CAR-T 最初在三线及以上环境中获得批准，现在已成为难治性疾病或初次化学免疫疗法后早期复发（12 个月内进展）患者的二线治疗标准护理 (SOC)。尽管成为 SOC，但大多数患者并未达到完全缓解，仅约 40% 的患者观察到长期治愈。因此，迫切需要更好地了解治疗失败的机制并识别不太可能从 SOC CAR-T 中受益的患者。该领域需要强大的生物标志物来预测治疗结果，因为更好地了解预后因素和耐药机制可以为预计对 SOC CAR-T 反应不佳的患者设计新的治疗方法提供信息。本综述旨在全面概述临床、分子、影像和细胞特征，这些特征已被证明会影响 R/R LBCL 患者的 CAR-T 治疗结果。© 2024 作者。约翰·威利 (John Wiley) 出版的 HemaSphere

CD19-directed autologous chimeric antigen receptor T cell (CAR-T) therapy has transformed the management of relapsed/refractory (R/R) large B cell lymphoma (LBCL). Initially approved in the third line and beyond setting, CAR-T is now standard of care (SOC) for second-line treatment in patients with refractory disease or early relapse (progression within 12 months) following primary chemoimmunotherapy. Despite becoming SOC, most patients do not achieve complete response, and long-term cure is only observed in approximately 40% of patients. Accordingly, there is an urgent need to better understand the mechanisms of treatment failure and to identify patients that are unlikely to benefit from SOC CAR-T. The field needs robust biomarkers to predict treatment outcome, as better understanding of prognostic factors and mechanisms of resistance can inform on the design of novel treatment approaches for patients predicted to respond poorly to SOC CAR-T. This review aims to provide a comprehensive overview of clinical, molecular, imaging, and cellular features that have been shown to influence outcomes of CAR-T therapy in patients with R/R LBCL.© 2024 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association.