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:CD19/CD20 Bispecific Chimeric Antigen Receptor (CAR) in Naive/Memory T Cells for the Treatment of Relapsed or Refractory Non-Hodgkin Lymphoma.
CART19/20 TN/MEM 细胞在复发/难治性 NHL 患者中安全有效,在低剂量水平即可实现持久缓解。
未标注:为解决抗原逃逸和T细胞功能丧失的问题,我们报告了一项I期临床试验(NCT04007029),评估自体初始和记忆T(TN/MEM)细胞经工程化表达双特异性抗CD19/CD20嵌合抗原受体(CAR;CART19/20)用于复发/难治性非霍奇金淋巴瘤(NHL)患者,以安全性为主要终点。10例患者接受了36×10^6至165×10^6个CART19/20细胞治疗。没有患者出现任何级别的神经毒性或超过1级的细胞因子释放综合征。观察到1例剂量限制性毒性(持续性血细胞减少)。10例患者中有9例达到客观缓解[90%总缓解率(ORR)],其中7例达到完全缓解[70%完全缓解(CR)率]。1例患者在CR 18个月后复发,但在接受第二剂CART19/20细胞后恢复CR。中位无进展生存期为18个月,中位总生存期未达到,中位随访时间为17个月。总之,CART19/20 TN/MEM细胞在复发/难治性NHL患者中安全有效,在低剂量水平即可实现持久缓解。意义:用于NHL患者的由TN/MEM细胞生成的自体CD19/CD20双特异性CAR-T细胞疗法是安全的(无神经毒性,最高1级细胞因子释放综合征),并在首次人体I期剂量递增试验中显示出强效(90% ORR,70% CR率)。本文在《本期特写》第517页中予以重点介绍。
UNLABELLED: To address antigen escape and loss of T-cell functionality, we report a phase I clinical trial (NCT04007029) evaluating autologous naive and memory T (TN/MEM) cells engineered to express a bispecific anti-CD19/CD20 chimeric antigen receptor (CAR; CART19/20) for patients with relapsed/refractory non-Hodgkin lymphoma (NHL), with safety as the primary endpoint. Ten patients were treated with 36 106 to 165 106 CART19/20 cells. No patient experienced neurotoxicity of any grade or over grade 1 cytokine release syndrome. One case of dose-limiting toxicity (persistent cytopenia) was observed. Nine of 10 patients achieved objective response [90% overall response rate (ORR)], with seven achieving complete remission [70% complete responses (CR) rate]. One patient relapsed after 18 months in CR but returned to CR after receiving a second dose of CART19/20 cells. Median progression-free survival was 18 months and median overall survival was not reached with a 17-month median follow-up. In conclusion, CART19/20 TN/MEM cells are safe and effective in patients with relapsed/refractory NHL, with durable responses achieved at low dosage levels. SIGNIFICANCE: Autologous CD19/CD20 bispecific CAR-T cell therapy generated from TN/MEM cells for patients with NHL is safe (no neurotoxicity, maximum grade 1 cytokine release syndrome) and demonstrates strong efficacy (90% ORR, 70% CR rate) in a first-in-human, phase I dose-escalation trial. This article is highlighted in the In This Issue feature, p. 517.
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