CAR-T（CAR-T）细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
社区移植与细胞治疗网络中 NHL 患者接受抗 CD19+ CAR-T 治疗的障碍
英文原题：Access barriers to anti-CD19+ CART therapy for NHL across a community transplant and cellular therapy network.
查看英文原题
Access barriers to anti-CD19+ CART therapy for NHL across a community transplant and cellular therapy network.
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中文摘要
我们分析了在基于社区的移植和细胞治疗网络注册中心内，非霍奇金淋巴瘤（NHL）患者获取抗CD19+CAR-T 细胞治疗的障碍。2018年至2022年间，共确定了357名获批抗CD19+ CAR-T 治疗的预期接受者。转诊时的中位年龄为61岁；转诊年份分别为2018年（4%）、2019年（14%）、2020年（18%）、2021年（26%）和2022年（38%）。诊断包括弥漫性大B细胞淋巴瘤（69%）、滤泡性淋巴瘤（13%）、滤泡性/大B细胞淋巴瘤（7%）、套细胞淋巴瘤（4%）或其他（7%）。
182名患者接受了axicabtagene ciloleucel（62%）、tisagenlecleucel（16%）、brexucabtagene autoleucel（13%）和lisocabtagene maraleucel（9%）输注。从转诊至会诊、会诊至单采以及采集至输注的中位时间分别为11天、107天和32天。从会诊至CAR-T 输注的中位时间从2019年的207天稳步下降至2022年的108天（P < .0001）。共有124名患者（41%）未接受CAR-T，主要原因为疾病进展（34%）或健康状况不佳（15%）。多变量logistic回归显示，与接受CAR-T 的患者相比，在人口统计学、经济或社会决定因素方面无显著差异。
值得注意的是，不符合条件的患者比例从2018-2020年的53%下降至2021-2022年的34%（P = .001）。
总之，41%的社区患者无法及时获得CAR-T 治疗，主要原因是疾病相关因素导致的脱落，且总体输注时间超过4个月。输注时间和接受CAR-T 的比例随时间有所改善。缩短至单采的时间、早期转诊以及关注挽救/桥接策略是必要的。
展开英文摘要原文
We analyzed access barriers to anti-CD19+ chimeric antigen receptor T cells (CARTs) for non-Hodgkin lymphoma (NHL) within a community-based transplant and cell therapy network registry. A total of 357 intended recipients for approved anti-CD19+ CARTs were identified between 2018 to 2022. The median age at referral was 61 years; referral years were 2018 (4%), 2019 (14%), 2020 (18%), 2021 (26%), and 2022 (38%). Diagnoses included diffuse large B cell (69%), follicular (13%), follicular/large (7%), mantle cell (4%), or other (7%). Axicabtagene ciloleucel (62%), tisagenlecleucel (16%), brexucabtagene autoleucel (13%), and lisocabtagene maraleucel (9 %) were infused into 182 patients.
The median durations between referral to consultation, consultation to apheresis, and collection to infusion were 11, 107, and 32 days, respectively. The median duration from consultation to CART infusion declined steadily from 207 days in 2019 to 108 days in 2022 (P < . 0001). A total of 124 patients (41%) did not receive CART, mostly for disease progression (34%) or poor health (15%). Multivariable logistic regression showed no significant differences in demographic, financial, or social determinants compared with those receiving CART.
Notably, the proportion of ineligible patients declined from 53% in 2018-2020 to 34% by 2021-2022 (P = . 001).
In conclusion, 41% of community patients were unable to access timely CART therapy, mostly due to attrition from disease-related causes, and the overall time to infusion exceeded 4 months. Time to infusion and the proportion receiving CARTs improved over time. Reducing time to apheresis, early referral, and attention to salvage/bridging strategies are necessary.
论文信息
- 作者
- Battiwalla M、Tees M、Flinn I、Pantin J、Berdeja J、Gregory T、Maris M、Bhushan V
- 第一作者单位
- Sarah Cannon Transplant and Cellular Therapy Network, HCA Healthcare, Nashville, TN.United States
- 通讯作者单位
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN.United States
- 期刊
- Blood advances2025 Jan 28
- 原文标识
- PubMed 39418599 · DOI 10.1182/bloodadvances.2024014171
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