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:CD30 CAR-T cells in combination with anti-PD-1 camrelizumab in relapsed/refractory CD30(+) lymphomas.
CD30 CAR T细胞疗法与camrelizumab联合应用在r/r cHL患者中展现出良好的安全性特征,并产生了持久且具有临床意义的缓解,其中包括既往PD-1阻断治疗失败的患者。相比之下,尽管该方案在治疗上仍耐受良好,但其在T细胞淋巴瘤中的抗肿瘤活性有限,凸显了在该疾病背景下需要替代方法或更有效的联合策略。
尽管靶向CD30的嵌合抗原受体(CAR)-T细胞疗法已在CD30+淋巴瘤中显示出抗肿瘤活性,但其治疗疗效仍不理想。因此,我们开展了一项前瞻性、II期、单臂、多中心临床试验(ChiCTR-2100046763),以评估CD30 CAR-T细胞疗法联合免疫检查点抑制剂卡瑞利珠单抗在复发/难治性(r/r)CD30+淋巴瘤患者中的疗效和安全性。
所有参与者均接受淋巴细胞清除预处理方案,随后输注剂量为 1 107 cells/kg 的 CD30 CAR-T 细胞。CAR-T 输注后 15 天起,按计划给予 Camrelizumab,并持续至出现不可接受的毒性或疾病进展。
共入组18例患者,其中12例(66.7%)完成了CD30 CAR-T输注,包括8例经典霍奇金淋巴瘤(cHL)和4例T细胞淋巴瘤。在11例可评估疗效的患者中,最佳客观缓解率(ORR)为63.6%,包括4例完全缓解(CR,36.3%)。中位随访30.8个月后,中位总生存期(OS)未达到,中位无进展生存期(PFS)为11.1个月(95% CI,0 26.2)。在7例cHL患者的亚组中,ORR和CR率分别为100.0%和57.1%,2年PFS和OS分别为57.1%和100.0%。值得注意的是,5例既往PD-1阻断治疗失败的cHL患者仍达到了100.0%的ORR和40.0%的CR率;中位OS未达到,中位PFS为15.0个月。相比之下,4例T细胞淋巴瘤患者均未达到客观缓解。8例患者(66.7%)发生了细胞因子释放综合征,均为1 2级。最常见的3 4级毒性为淋巴细胞减少(58.3%)和中性粒细胞减少(41.7%)。
INTRODUCTION: Although CD30-directed chimeric antigen receptor (CAR)-T cell therapy has demonstrated antitumor activity in CD30+ lymphomas, its therapeutic efficacy remains suboptimal. We therefore conducted a prospective, phase II, single-arm, multicenter clinical trial (ChiCTR-2100046763) to evaluate the efficacy and safety of CD30 CAR-T cell therapy in combination with camrelizumab, an immune checkpoint inhibitor, in patients with relapsed/refractory (r/r) CD30+ lymphomas. METHODS: All participants received a lymphodepleting regimen followed by infusion of CD30 CAR-T cells at a dose of 1 107 cells/kg. Camrelizumab was subsequently administered on a scheduled basis starting 15 days after CAR-T infusion and continued until unacceptable toxicity or disease progression. RESULTS: A total of 18 patients were enrolled, of whom 12 (66.7%) completed the CD30 CAR-T infusion, including eight with classical Hodgkin lymphoma (cHL) and four with T-cell lymphomas. Among 11 efficacy-evaluable patients, the best objective response rate (ORR) was 63.6%, including four complete responses (CR, 36.3%). After a median follow-up of 30.8 months, the median overall survival (OS) was not reached, and the median progression-free survival (PFS) was 11.1 months (95% CI, 0 26.2). In the subset of seven cHL patients, the ORR and CR rates were 100.0% and 57.1%, with 2-year PFS and OS of 57.1% and 100.0%, respectively. Remarkably, five cHL patients who had previously failed PD-1 blockade still achieved an ORR of 100.0% and a CR rate of 40.0%; median OS was not reached, and median PFS was 15.0 months. In contrast, none of the four T-cell lymphoma patients achieved an objective response. Cytokine release syndrome occurred in eight patients (66.7%), all grade 1 2. The most frequent grade 3 4 toxicities were lymphopenia (58.3%) and neutropenia (41.7%). CONCLUSIONS: The combination of CD30 CAR T-cell therapy with camrelizumab demonstrated a favorable safety profile and elicited durable, clinically meaningful responses in patients with r/r cHL, including those who had failed prior PD-1 blockade. In contrast, although this regimen remained therapeutically well tolerated, its antitumor activity was limited in T-cell lymphomas, underscoring the need for alternative approaches or more effective combinatorial strategies in this disease context.
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