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:Non-gene-edited, CD19-targeted, allogeneic CAR-T cell therapy for relapsed or refractory B-cell acute lymphoblastic leukemia: an open-label, single-arm phase 1 study.
在中位随访31个月时,1年无进展生存率和总生存率分别为30%和40%。
自体嵌合抗原受体(CAR)-T细胞疗法对复发或难治性B细胞急性淋巴细胞白血病(R/R B-ALL)有效,但其临床应用受到生产失败、高成本和可及性有限的限制。基因编辑的同种异体CAR-T细胞提供了一种现货型替代方案,但关于基因组不稳定性和移植物抗宿主病(GVHD)的担忧仍然存在。我们开展了一项1期研究,评估ThisCAR-T——一种非基因编辑的、靶向CD19的同种异体CAR-T细胞产品——在R/R B-ALL患者中的安全性和疗效。11例患者接受了递增剂量ThisCAR-T治疗,分别为1 10 6、3 10 6和5 10 6个细胞/kg。1例患者在输注后退出。在其余10例患者中,8例发生细胞因子释放综合征,其中7例为1-2级,1例为3级。2例患者发生免疫效应细胞相关神经毒性综合征(分别为1级和4级)。未观察到GVHD。在第28天,9例可评估患者中有8例达到完全缓解(CR)或伴血液学恢复不完全的CR(CRi)。在中位随访31个月时,1年无进展生存率和总生存率分别为30%和40%。ThisCAR-T表现出良好的安全性和有前景的抗白血病活性,支持其作为R/R B-ALL新型疗法的潜力。
Autologous chimeric antigen receptor (CAR)-T cell therapy is effective in relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL), but its clinical application is restricted by manufacturing failures, high costs, and limited accessibility. Gene-edited allogeneic CAR-T cells offer an off-the-shelf alternative, yet concerns remain regarding genomic instability and graft-versus-host disease (GVHD). We conducted a phase 1 study to assess the safety and efficacy of ThisCAR-T, a non-gene-edited, CD19-directed allogeneic CAR-T cell product, in patients with R/R B-ALL. Eleven patients were treated with escalating doses of ThisCAR-T at 1 10 6 , 3 10 6 , and 5 10 6 cells/kg. One patient withdrew after infusion. Among the remaining ten patients, eight developed cytokine release syndrome, including seven with grade 1-2 and one with grade 3. Immune effector cell-associated neurotoxicity syndrome occurred in two patients (grade 1 and grade 4, respectively). No GVHD was observed. At day 28, 8 of 9 evaluable patients achieved complete remission (CR) or CR with incomplete hematologic recovery (CRi). At a median follow-up of 31 months, the 1-year progression-free survival and overall survival rates were 30% and 40%, respectively. ThisCAR-T demonstrated a favorable safety and promising antileukemic activity, supporting its potential as a novel therapy for R/R B-ALL.
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