CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
CD19 阳性与 CD19 阴性复发的决定因素在 tisagenlecleucel 治疗 B 细胞急性淋巴细胞白血病后
英文原题：Determinants of CD19-positive vs CD19-negative relapse after tisagenlecleucel for B-cell acute lymphoblastic leukemia.
查看英文原题
Determinants of CD19-positive vs CD19-negative relapse after tisagenlecleucel for B-cell acute lymphoblastic leukemia.
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中文摘要
Tisagenlecleucel 治疗对复发/难治性（R/R）B 细胞前体急性淋巴细胞白血病（BCP-ALL）显示出有前景的疗效。
然而，30-50% 的患者会出现复发。CD19 阳性与 CD19 阴性复发的决定因素尚不明确。我们报告了 51 例 R/R BCP-ALL 患者（中位年龄 17 岁），在淋巴细胞清除后输注 tisagenlecleucel。D28 时完全缓解率为 96%。既往 blinatumomab 治疗增加了 D28 时早期失败的风险。在中位随访 15.5 个月时，18 个月累积复发率（CIR）、无事件生存率（EFS）和总生存率（OS）分别为 51%、44% 和 74%。与高肿瘤负荷相关的因素（细胞因子释放综合征的发生）以及既往 blinatumomab 治疗与 CIR 增加以及 EFS 和 OS 缩短相关。淋巴细胞清除前高疾病负荷（MRD ≥ 10 -2，SHR 10.4，p = 0.03）和 D28 时可检测到 MRD（SHR 7.2，p = 0.006）与 CD19 阴性复发风险增加相关。低疾病负荷（SHR 5.3，p = 0.03）和 B 细胞再生障碍（BCA）丧失（SHR 21.7，p = 0.004）预测 CD19 阳性复发风险增加。这些数据强调了既往治疗对患者结局的影响。
最后，D28 时可检测到 MRD 和 BCA 丧失均定义了复发高风险患者，这些患者需要额外干预。
展开英文摘要原文
Tisagenlecleucel therapy has shown promising efficacy for relapsed/refractory (R/R) B-cell precursor acute lymphoblastic leukemia (BCP-ALL).
However, relapses occur in 30-50% of patients. Determinants for CD19 pos versus CD19 neg relapses are poorly characterized.
We report on 51 patients with R/R BCP-ALL (median age 17 years) infused with tisagenlecleucel after lymphodepletion. Complete remission rate at D28 was 96%. Prior blinatumomab increased the risk of early failure at D28. The 18-month cumulative incidence of relapse (CIR), event-free survival (EFS), and overall survival (OS) were 51%, 44%, and 74%, respectively, at a median follow-up of 15. 5 months.
Factors associated with a high tumor burden (occurrence of cytokine release syndrome) and prior blinatumomab were associated with an increased CIR, and a shorter EFS and OS. Pre-lymphodepletion high disease burden (MRD ≥ 10 -2 , SHR 10. 4, p = 0. 03) and detectable MRD at D28 (SHR 7.
2, p = 0. 006) correlated with an increased risk of CD19 neg relapse. Low disease burden (SHR 5. 3, p = 0. 03) and loss of B-cell aplasia (BCA) (SHR 21. 7, p = 0. 004) predicted an increased risk of CD19 pos relapses. These data highlight the impact of prior therapy on patient outcome.
Finally, detectable MRD at D28 and loss of BCA both define patients at high risk of relapse for whom additional interventions are needed.
论文信息
- 作者
- Dourthe ME、Rabian F、Yakouben K、Chevillon F、Cabannes-Hamy A、Méchinaud F、Grain A、Chaillou D
- 第一作者单位
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France.France
- 通讯作者单位
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France. andre.baruchel@aphp.fr.France
- 期刊
- Leukemia2021 Dec
- 原文标识
- PubMed 34002027 · DOI 10.1038/s41375-021-01281-7