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:Five-Year Follow-Up: Tandem CD19/CD20 CAR T Therapy Enduring Impact on Refractory/Relapsed Non-Hodgkin Lymphoma.
在87例接受TanCAR7治疗的r/r NHL患者中,客观缓解率为78%(完全缓解率,70%),中位随访时间为63.4个月。
在这项单臂、单中心、注册性2期试验中,串联CD19/CD20嵌合抗原受体(CAR)T细胞(TanCAR7)疗法在复发/难治性非霍奇金淋巴瘤(r/r NHL)患者中显示出有前景的疗效和安全性。在此,我们报告5年随访结果,包括对持久缓解、生存和安全的评估。我们还研究了与治疗耐药或复发相关的危险因素和生物标志物,并评估了CAR-T细胞治疗失败后的挽救治疗。在87例接受TanCAR7治疗的r/r NHL患者中,中位随访时间为63.4个月,客观缓解率为78%(完全缓解率,70%)。截至数据截止时,40%的患者仍处于缓解状态。中位总生存期(OS)未达到,估计5年OS率为60.1%,中位无进展生存期(PFS)为33个月。未观察到新的或意外的TanCAR7相关严重不良事件或死亡。高肿瘤负荷和全身炎症是耐药和复发的危险因素。除外周血中CAR-T细胞扩增外,输注后高水平的内源性CD8 + T细胞和总淋巴细胞与治疗获益相关。TanCAR7失败后的挽救性化疗疗效有限,而靶向治疗或二次CAR-T细胞治疗在一部分患者中实现了临床缓解。这是首个针对双靶点CAR T细胞疗法的5年随访分析,显示r/r NHL患者具有长期缓解潜力,且无新的安全性信号。试验注册:ClinicalTrials.gov:NCT03097770。
In this single-arm, single-center, registrational phase 2 trial, tandem CD19/CD20 chimeric antigen receptor (CAR) T cell (TanCAR7) therapy showed promising efficacy and safety in patients with relapsed/refractory non-Hodgkin's lymphoma (r/r NHL). Here, we report 5-year follow-up results, including assessments of durable response, survival, and safety. We also investigated risk factors and biomarkers associated with treatment resistance or relapse and evaluated salvage therapies after CAR-T cell failure. Among 87 patients with r/r NHL treated with TanCAR7, the objective response rate was 78% (complete remission rate, 70%) with a median follow-up of 63.4 months. At data cut-off, 40% of patients remained in remission. Median overall survival (OS) was not reached, with an estimated 5-year OS rate of 60.1% and median progression-free survival (PFS) of 33 months. No new or unexpected TanCAR7-related serious adverse events or deaths were observed. High tumor burden and systemic inflammation were risk factors for resistance and relapse. In addition to CAR-T cell expansion in peripheral blood, high levels of endogenous CD8 + T cells and total lymphocytes after infusion correlated with treatment benefit. Salvage chemotherapy post TanCAR7 failure showed limited efficacy, whereas targeted therapy or secondary CAR-T cell therapy achieved clinical responses in a subset of patients. This first-ever 5-year follow-up analysis of a dual-targeted CAR T-cell therapy shows long-term remission potential and no new safety signals in patients with r/r NHL. Trial Registration: ClinicalTrials.gov: NCT03097770.
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