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:A safety and efficacy study of allogeneic haematopoietic stem cell transplantation for refractory and relapsed T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma patients who achieved complete remission after autologous CD7 chimeric antigen receptor T-cell therapy.
我们的研究表明,CD7 CAR-T 疗法序贯 allo-HSCT 对 r/r T-ALL/LBL 患者不仅有效且安全,其结局也与通过化疗达到 CR 的患者相当,且未增加 NRM。
靶向CD7的CAR-T 细胞治疗难治或复发(r/r)T细胞急性淋巴细胞白血病和淋巴母细胞淋巴瘤(T-ALL/LBL)已显示出良好的初始完全缓解(CR)率。为延长缓解持续时间,研究者考虑以异基因造血干细胞移植(allo-HSCT)进行巩固。本研究分析34例r/r T-ALL/LBL患者在自体CD7 CAR-T治疗达到CR后接受allo-HSCT的结局,并与124例化疗达到CR后接受allo-HSCT的连续患者进行比较。结果显示,CAR-T组和化疗组2年总生存率(OS)相近,分别为61.9%(95% CI 44.1–78.1)和67.6%(95% CI 57.5–76.9;p=0.210);无白血病生存率(LFS)分别为62.3%(95% CI 44.6–78.4)和62.0%(95% CI 51.8–71.7;p=0.548);非复发死亡率(NRM)分别为32.0%(95% CI 19.0–54.0)和25.3%(95% CI 17.9–35.8;p=0.288);复发率分别为8.8%(95% CI 3.0–26.0)和15.8%(95% CI 9.8–25.2;p=0.557)。CD7 CAR-T组中年龄≤14岁的患者2年OS和LFS均较高,达到87.5%。研究提示,CD7 CAR-T后序贯allo-HSCT治疗r/r T-ALL/LBL有效且安全,结局与化疗达到CR后移植的患者相当,且未增加NRM。
CD7-targeted chimeric antigen receptor T-cell (CAR-T) therapy has shown promising initial complete remission (CR) rates in patients with refractory or relapsed (r/r) T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma (T-ALL/LBL). To enhance the remission duration, consolidation with allogeneic haematopoietic stem cell transplantation (allo-HSCT) is considered. Our study delved into the outcomes of 34 patients with r/r T-ALL/LBL who underwent allo-HSCT after achieving CR with autologous CD7 CAR-T therapy. These were compared with 124 consecutive T-ALL/LBL patients who received allo-HSCT in CR following chemotherapy. The study revealed that both the CAR-T and chemotherapy cohorts exhibited comparable 2-year overall survival (OS) (61.9% [95% CI, 44.1-78.1] vs. 67.6% [95% CI, 57.5-76.9], p = 0.210), leukaemia-free survival (LFS) (62.3% [95% CI, 44.6-78.4] vs. 62.0% [95% CI, 51.8-71.7], p = 0.548), non-relapse mortality (NRM) rates (32.0% [95% CI, 19.0-54.0] vs. 25.3% [95% CI, 17.9-35.8], p = 0.288) and relapse incidence rates (8.8% [95% CI, 3.0-26.0] vs. 15.8% [95% CI, 9.8-25.2], p = 0.557). Patients aged 14 in the CD7 CAR-T group achieved high 2-year OS and LFS rates of 87.5%. Our study indicates that CD7 CAR-T therapy followed by allo-HSCT is not only effective and safe for r/r T-ALL/LBL patients but also on par with the outcomes of those achieving CR through chemotherapy, without increasing NRM.
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