决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Successful application of PD-1 knockdown CLL-1 CAR-T therapy in two AML patients with post-transplant relapse and failure of anti-CD38 CAR-T cell treatment.
在末次随访时,病例 1 和病例 2 分别维持持续缓解 8 个月和 3 个月。
复发/难治性急性髓系白血病(R/R AML)患者常对化疗耐药,预后极差,因此亟需开发新的治疗策略。CAR-T 细胞疗法在B细胞恶性肿瘤治疗中取得巨大进展,推动了许多针对R/R AML开发CAR-T疗法的工作,但成功有限,部分原因是缺乏特异性靶点。C型凝集素样分子1(CLL-1)在AML原始细胞上高表达,而正常造血干细胞上不表达,因此是AML免疫治疗的理想靶点。我们报告2例异基因干细胞移植后复发、且包括抗CD38 CAR-T治疗在内的多线挽救治疗失败的R/R AML患者;两例均成功接受PD-1沉默的抗CLL-1 CAR-T治疗。在输注CLL-1 CAR-T细胞后第28天评估时,两例患者均达到分子学完全缓解,但血液学恢复不完全。病例1和病例2分别发生1级和2级细胞因子释放综合征。末次随访时,两例患者分别已持续缓解8个月和3个月。结果表明,CLL-1 CAR-T细胞可能是移植后复发AML患者有效且安全的挽救治疗。
Patients with relapsed/refractory acute myeloid leukemia (R/R AML) often show resistance to chemotherapy and have dismal outcomes. Therefore, it is urgent to develop new treatment strategies to address this problem. With tremendous achievement of chimeric antigen receptor T cells (CAR-T) therapy against B-cell malignancies, many efforts have been devoted to developing CAR-T therapy for R/R AML but with limited success, in part owing to a lack of specific targets. C-type lectin-like molecule-1 (CLL-1) is highly expressed on AML blasts with no expression on normal hematopoietic stem cells, which makes it an ideal target of immunotherapy for AML. Here, we report 2 R/R AML patients who relapsed after allogeneic stem cell transplantation and failed multiline salvage therapies including anti-CD38 CAR-T therapy, but were successfully treated with PD-1 silenced anti-CLL-1 CAR-T therapy. Both patients achieved molecular complete remission with incomplete hematologic recovery at 28 days of evaluation after CLL-1 CAR-T cell infusion. Cytokine release syndrome in cases 1 and 2 were grade 1 and 2, respectively. At the last follow-up, cases 1 and 2 had maintained continuous remission for 8 and 3 months, respectively. Our results demonstrated that CLL-1 CAR-T cells might be an effective and safe salvage therapy for AML patients with posttransplant relapse.
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