弥散性中线胶质瘤（DMG）是一种致命的儿童中枢神经系统癌症。DMG的位置和浸润性特性使手术切除变得不可能，并且姑息性放疗的效益是暂时的；中位总生存期（OS）为9-11个月。肿瘤免疫微环境（TIME）是“冷”的，并且具有主导性免疫抑制的髓样细胞组分，浸润性淋巴细胞和促炎分子水平较低。由于生存统计数据在过去几十年来一直停滞不前，而且迫切需要针对DMG独特生物学的治疗方法，这促使临床评估嵌合抗原受体（CAR）T细胞疗法在这种情况下的应用。我们重点介绍了DMG CAR T细胞疗法的当前进展，并强调TIME在治疗反应中可能发挥的作用，以及克服治疗障碍的策略。版权所有©2023 Elsevier Inc. 出版，保留所有权利。

Diffuse midline glioma (DMG) is a fatal pediatric cancer of the central nervous system (CNS). The location and infiltrative nature of DMG prevents surgical resection and the benefits of palliative radiotherapy are temporary; median overall survival (OS) is 9-11 months. The tumor immune microenvironment (TIME) is 'cold', and has a dominant immunosuppressive myeloid compartment with low levels of infiltrating lymphocytes and proinflammatory molecules. Because survival statistics have been stagnant for many decades, and therapies targeting the unique biology of DMG are urgently needed, this has prompted the clinical assessment of chimeric antigen receptor (CAR) T cell therapies in this setting. We highlight the current landscape of CAR T cell therapy for DMG, the role the TIME may play in the response, and strategies to overcome treatment obstacles.Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.