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:Myelodysplastic syndrome following chimeric antigen receptor T-cell therapy treated with allogenic stem cell transplantation.
持续性血液学毒性是 CAR-T 细胞治疗后新出现的关注点,发生于 30% 的患者,机制尚不明确。
嵌合抗原受体(CAR)T细胞疗法目前已获批用于治疗B细胞非霍奇金淋巴瘤和B细胞急性淋巴细胞白血病。CAR-T治疗后长期血液学毒性是新近受到关注的问题,约30%的患者发生此毒性,但其机制尚不清楚。此前报道的少数CAR-T治疗后骨髓增生异常综合征(MDS)病例,被认为与既往多线化疗有关。作者报告一例弥漫大B细胞淋巴瘤患者接受axicabtagene ciloleucel治疗后,第28天出现长期血液学毒性。随访期间患者被诊断为MDS,并接受异基因造血干细胞移植。移植后19个月,患者的淋巴瘤和MDS均维持完全缓解。CAR-T细胞是一种近期获验证、用于部分B细胞淋巴瘤和白血病的新型免疫疗法。近期报道的CAR-T副作用之一是贫血、血小板减少和/或中性粒细胞减少持续较长时间。作者报告一例非霍奇金淋巴瘤患者接受CAR-T后发生长期血液学毒性;随访中确诊MDS,患者接受异基因骨髓移植,末次随访时仍处于完全缓解。
Chimeric antigen receptor (CAR) T-cell therapy is currently approved for the treatment of B-cell non-Hodgkin lymphomas and B-cell acute lymphoblastic leukemia. Prolonged hematological toxicity is an emergent concern following CAR T cells and occurred in 30% of patients with unknown mechanism. Few cases of myelodysplastic syndrome (MDS) following CAR T-cell therapy were reported and attributed to previous chemotherapies in heavily pretreated patients. The authors report the case of a patient with diffuse large B-cell lymphoma treated with axicabtagene ciloleucel who developed prolonged hematological toxicity by day 28. During the follow-up, the diagnosis of MDS was made. The patient underwent allogenic hematological stem cell transplantation. The patient remains in complete remission of his lymphoma and MDS 19 months after hematological stem cell transplantation. Chimeric antigen receptor (CAR) T cell is a new type of immunotherapy that was recently validated for the treatment of some types of B-cell lymphoma and leukemia. One of the most recently reported side effects of CAR T cells is the appearance of anemia, thrombocytopenia and/or neutropenia lasting for a long duration. The authors report the case of a patient treated with CAR T cells for non-Hodgkin lymphoma who developed prolonged hematological toxicity. During follow-up, the diagnosis of myelodysplastic syndrome was made and the patient underwent allogenic bone marrow transplantation and remains in complete remission at last follow-up.
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