癌症免疫治疗学会(SITC)关于急性白血病免疫治疗的临床实践指南,2.0 版
Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of acute leukemia, version 2.0.
急性白血病是一种影响所有年龄段的血液系统恶性肿瘤。
英文原题:CMV-specific T-cell receptor-engineered T-cell therapy as first-line treatment for CMV reactivation after haploidentical hematopoietic stem cell transplantation: a phase 2 trial.
CMV-specific T-cell receptor-engineered T-cell therapy as first-line treatment for CMV reactivation after haploidentical hematopoietic stem cell transplantation: a phase 2 trial.
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这些发现凸显了 TCR-T 细胞作为单倍型造血干细胞移植后 CMV 再激活一线治疗的长期疗效和安全性。
我们开展II期试验,在更大队列中评估既往确定的最高剂量作为一线治疗的疗效和安全性。连续两次检测CMV DNA>1×10^3拷贝/mL,或单次检测>1×10^4拷贝/mL时,患者接受CMV TCR-T细胞输注(5×10^5个细胞/kg)。若7天内未检测到TCR-T细胞扩增,且CMV载量仍>1×10^3拷贝/mL,则给予第二次输注。若3周后未达到完全缓解(CR),则启动挽救治疗。主要终点为4周CR率。TCR-T细胞来源于健康供者。
入组25例患者中,13例发生CMV再激活并接受TCR-T细胞治疗。至第4周,12例(12/13,92.3%;95% CI:66.7%–98.6%)达到CR。达到CR者中,11例(11/12,91.7%;95% CI:64.6%–98.5%)在未继续抗病毒治疗的情况下维持CR;输注后中位随访1,011天(范围657–1,561天)。发生2例1级细胞因子释放综合征(CRS)。TCR拷贝数在14天内增加10^4倍,并可检测到4个月。 讨论:这些结果凸显TCR-T细胞作为haplo-HSCT后CMV再激活一线疗法的长期疗效和安全性。 试验注册:ClinicalTrials.gov,NCT05140187。
We conducted a phase 2 trial using the previously established highest dose to evaluate efficacy and safety as first-line therapy in a larger cohort. Patients received CMV TCR-T cell infusions (5 10 5 cells/kg) upon detection of >1 10 3 copies/mL CMV DNA in two consecutive tests or >1 10 4 copies/mL once. A second infusion was administered when TCR-T cell expansion remained undetectable within 7 days, and CMV load remained above 1 10 3 copies/mL. Salvage therapy was initiated when complete remission (CR) was not achieved after 3 weeks. The primary endpoint was the 4-week CR rate. TCR-T cells were derived from healthy donors.
Among 25 patients enrolled, 13 developed CMV reactivation and received TCR-T cell therapy. Twelve (12/13, 92.3%, 95% CI: 66.7%-98.6%) achieved CR by week 4. Eleven (11/12, 91.7%, 95% CI: 64.6%-98.5%) maintained CR without further antiviral therapy, with median follow-up of 1011 (range: 657-1561) days post-infusion. Two cases of grade 1 cytokine release syndrome (CRS) occurred. TCR copy number increased 10 4 -fold within 14 days and remained detectable for 4 months. DISCUSSION: These findings highlight the long-term efficacy and safety of TCR-T cells as first-line therapy for CMV reactivation post-haplo-HSCT. TRIAL REGISTRATION: www.clinicaltrials.gov, identifier NCT05140187.
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