Monoclonal antibodies (mAbs) have become a cornerstone in the treatment of follicular lymphoma (FL), offering highly specific therapeutic targeting that enhances efficacy while minimizing systemic toxicity. Their mechanisms of action include antibody-dependent cellular cytotoxicity (ADCC), complement-dependent cytotoxicity (CDC), and direct apoptotic signaling, effectively mediating malignant B-cell depletion. Anti-CD20 mAbs, such as rituximab and obinutuzumab, have significantly improved progression-free survival (PFS) and overall survival (OS), establishing immunochemotherapy as the standard of care for FL. However, the emergence of treatment resistance, often characterized by CD20 antigen downregulation or immune escape, has prompted the development of next-generation mAbs with enhanced effector functions. Bispecific antibodies (BsAbs), which simultaneously engage CD20-expressing tumor cells and CD3-positive cytotoxic T cells, have emerged as a novel immunotherapeutic strategy, redirecting T-cell activity to eliminate malignant B cells independently of major histocompatibility complex (MHC) antigen presentation. Additionally, antibody–drug conjugates (ADCs) offer a targeted cytotoxic approach by delivering potent chemotherapeutic payloads directly to tumor cells while limiting off-target effects. The integration of mAbs with immune checkpoint inhibitors and immunomodulatory agents is further enhancing treatment outcomes by overcoming immunosuppressive mechanisms within the tumor microenvironment. Despite these advancements, challenges remain, including optimizing the treatment sequence, mitigating immune-related toxicities—particularly cytokine release syndrome (CRS)—and identifying predictive biomarkers to guide patient selection. As the role of monoclonal antibodies continues to expand, their integration into therapeutic regimens is transforming the management of FL, paving the way for chemotherapy-free treatment approaches and long-term disease control. This review provides an updated overview of mAbs therapies for FL, emphasizing the advances brought by BsAbs and ADCs toward more tailored and effective treatments.
单克隆抗体已成为滤泡性淋巴瘤治疗的基石，通过高度特异性的靶向治疗在提升疗效的同时最大限度降低全身毒性。其作用机制包括抗体依赖性细胞介导的细胞毒性、补体依赖性细胞毒性以及直接诱导凋亡信号，从而有效介导恶性B细胞的清除。以利妥昔单抗和奥妥珠单抗为代表的抗CD20单克隆抗体显著改善了患者的无进展生存期和总生存期，确立了免疫化疗作为滤泡性淋巴瘤标准治疗的地位。然而，以CD20抗原下调或免疫逃逸为特征的耐药现象促使了具有增强效应功能的下一代单抗的研发。双特异性抗体通过同时结合表达CD20的肿瘤细胞与CD3阳性细胞毒性T细胞，形成新型免疫治疗策略，可引导T细胞活性以非主要组织相容性复合体依赖的方式清除恶性B细胞。此外，抗体药物偶联物通过向肿瘤细胞精准递送强效化疗载荷，在限制脱靶效应的同时实现了靶向细胞毒性治疗。单克隆抗体与免疫检查点抑制剂及免疫调节剂的联合应用，通过克服肿瘤微环境中的免疫抑制机制进一步提升了治疗效果。尽管取得这些进展，仍面临诸多挑战，包括优化治疗顺序、减轻免疫相关毒性（特别是细胞因子释放综合征），以及建立指导患者选择的预测性生物标志物体系。随着单克隆抗体治疗角色的持续拓展，其与治疗方案的整合正在改变滤泡性淋巴瘤的治疗格局，为无化疗治疗方案和长期疾病控制开辟了新路径。本综述系统阐述了滤泡性淋巴瘤单克隆抗体治疗的最新进展，重点探讨双特异性抗体与抗体药物偶联物为实现更精准有效治疗带来的突破。
Single-Agent and Associated Therapies with Monoclonal Antibodies: What About Follicular Lymphoma?
肿瘤(癌症)患者之家