抗 CD19 嵌合抗原受体 T 细胞疗法 (CART) 彻底改变了复发性和/或难治性 B 细胞非霍奇金淋巴瘤的治疗结果。然而，CART 仍然受到其可用性、毒性和响应持久性的限制。由于疾病进展，并非所有患者都能进入 CART 输注阶段。在接受 CART 治疗的患者中，相当多的患者经历了危及生命的细胞因子释放综合征毒性，只有不到一半的患者能够维持持久的反应，大多数患者在 CART 治疗前已有的疾病部位复发。放射治疗是一种有前景的围 CART 和抢救治疗，可以改善这些患者的预后。有证据表明，CART 之前的桥接放疗可以在生产期间控制疾病，提高缓解率和局部控制，减少/减轻疾病并降低细胞因子释放综合征的严重程度，并可能延长无病间隔和生存期，尤其是对于患有以下疾病的患者：体积大的疾病。针对 CART 后残留疾病的巩固放疗改变了复发模式，并提高了局部无复发和无进展生存率。当对有限复发疾病的患者进行全面治疗时，针对 CART 后复发疾病的挽救性放射治疗具有良好的生存结果，并且可以减轻弥漫性复发疾病患者的症状。围 CART 期间该疾病的生物学知之甚少，需要进一步研究放射治疗 (RT) 的最佳时机和剂量。在本次综述中，我们解决了 CART 面临的最重大挑战，回顾并提出了 RT 如何帮助缓解这些挑战，并提供了 Mayo Clinic 专家将 RT 与 CART 相结合的方法。© 2023 Wiley periodicals LLC。

Anti-CD19 chimeric antigen receptor T-cell therapy (CART) has revolutionized the outcomes of relapsed and/or refractory B-cell non-Hodgkin lymphoma. However, CART is still limited by its availability, toxicity, and response durability. Not all patients make it to the CART infusion phase due to disease progression. Among those who receive CART, a significant number of patients experience life-threatening cytokine release syndrome toxicity, and less than half maintain a durable response with the majority relapsing in pre-existing sites of disease present pre-CART. Radiation therapy stands as a promising peri-CART and salvage treatment that can improve the outcomes of these patients. Evidence suggests that bridging radiotherapy prior to CART controls the disease during the manufacturing period, augments response rates and local control, cytoreduces/debulks the disease and decreases the severity of cytokine release syndrome, and may prolong disease-free intervals and survival especially in patients with bulky disease. Consolidative radiotherapy for residual post-CART disease alters the pattern of relapse and improves local recurrence-free and progression-free survivals. Salvage radiotherapy for relapsed post-CART disease has favorable survival outcomes when delivered comprehensively for patients with limited relapsed disease and palliates symptoms for patients with diffuse relapsed disease. The biology of the disease during the peri-CART period is poorly understood, and further studies investigating the optimal timing and dosing of radiation therapy (RT) are needed. In this review, we tackle the most significant challenges of CART, review and propose how RT can help mitigate these challenges, and provide The Mayo Clinic experts' approach on incorporating RT with CART.© 2023 Wiley Periodicals LLC.