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.
英文原题:Long-term outcomes of GD2-directed CAR-T cell therapy in patients with neuroblastoma.
Long-term outcomes of GD2-directed CAR-T cell therapy in patients with neuroblastoma.
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在一项于2004年至2009年开放入组的1期临床试验中,我们用EBV(Epstein-Barr病毒)特异性T淋巴细胞和CD3活化T细胞治疗神经母细胞瘤患儿,这些细胞均表达靶向GD2的CAR,但不含嵌入的共刺激序列(第一代CAR)。这些CAR整合了条形码序列,以追踪每一回输的细胞群。
我们既往报告了长达5年的结局,现在报告长达18年的长期结局。在11例回输时有活动性疾病的患者中,3例获得完全缓解,其中2例维持缓解,1例维持8年直至失访,另1例维持超过18年。在8例接受CAR-T 时无疾病证据的患者中,5例在回输后10年至15年间的末次随访时无病。随访期间检测到间歇性低水平转基因,且在长期生存者中持续存在显著更久。尽管使用的是因缺乏共刺激结构域而已不再采用的第一代载体,复发/难治性神经母细胞瘤患者在接受GD2 CAR-T 细胞治疗后仍实现了长期疾病控制,包括1例复发疾病现已缓解超过18年的患者。ClinicalTrials.gov标识符:NCT00085930。
In a phase 1 clinical trial open to accrual from 2004 to 2009, we treated children with neuroblastoma with Epstein-Barr virus (EBV)-specific T lymphocytes and CD3-activated T cells-each expressing chimeric antigen receptors (CARs) targeting GD2 but without an embedded co-stimulatory sequence (first-generation CARs). These CARs incorporated barcoded sequences to track each infused population.
We previously reported outcomes up to 5 years and now report long-term outcomes up to 18 years. Of 11 patients with active disease at infusion, three achieved a complete response that was sustained in two patients, one for 8 years until lost to follow-up and one for more than 18 years. Of eight patients with no evidence of disease at the time of CAR-T administration, five are disease free at their last follow-up between 10 years and 15 years after infusion.
Intermittent low levels of transgene were detected during the follow-up period with significantly greater persistence in those who were long-term survivors. Despite using first-generation vectors that are no longer employed because of the lack of co-stimulatory domains, patients with relapsed/refractory neuroblastoma achieved long-term disease control after receiving GD2 CAR-T cell therapy, including one patient now in remission of relapsed disease for more than 18 years. ClinicalTrials. gov identifier: NCT00085930 .
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