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:Long-term follow-up of third generation anti-CD30 CAR T-cell therapy in relapsed/refractory CD30+ lymphomas: a single-arm, multicentre, phase 1-2 trial.
第三代抗CD30 CAR-T在r/r CD30+淋巴瘤患者中显示出高疗效和良好的安全性。在CAR T细胞治疗后加用auto-HSCT可提高缓解深度,并可能改善OS和PFS。
本报告呈现第三代抗CD30 CAR T细胞疗法在复发/难治性(r/r)CD30+淋巴瘤患者中的长期结局。
在这项单臂、多中心、1/2期试验中,患者接受了由氟达拉滨和环磷酰胺组成的淋巴细胞清除方案,随后输注抗CD30 CAR-T细胞。主要终点包括安全性和总缓解率(ORR),次要终点为无进展生存期(PFS)和总生存期(OS)。
共入组44例患者,其中33例为霍奇金淋巴瘤。44例患者中,23例对CAR-T达到完全缓解(CR),19例达到PR,CR率为52.3%,ORR为95.5%。最常见的毒性为3级或以上血液学AE(68.2%为中性粒细胞减少)。细胞因子释放综合征发生于18例患者(40.9%),其中2例(4.5%)为3级。在随访期间,24例患者在CAR-T后中位3个月内接受了auto-HSCT。最佳ORR为95.5%,27例患者(61.4%)达到CR。接受CAR-T后序贯auto-HSCT的患者最佳CR率高于仅接受CAR-T的患者(75% vs. 45%)。所有患者的3年OS率和PFS率分别为79.0%(95%CI,66.1%-91.9%)和74.2%(95%CI,60.3%-88.1%)。与仅接受CAR-T治疗的患者相比,在CAR-T后接受巩固性auto-HSCT的患者OS和PFS显著更长。
PURPOSE: This report presents long-term outcomes of third-generation anti-CD30 CAR T-cell therapy in relapsed/refractory (r/r) CD30+ lymphoma patients. PATIENTS AND METHODS: In this single-arm, multicentre, phase 1/2 trial, patients received lymphodepletion regimen comprising fludarabine and cyclophosphamide, followed by infusion of anti-CD30 CAR-T cells. Primary endpoints included safety and overall response rate (ORR), while secondary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS: Forty-four patients were enrolled, including 33 cases of Hodgkin lymphoma. Of 44 patients, 23 achieved complete response (CR) to CAR-T, and 19 achieved PR, resulting in a CR rate of 52.3% and an ORR of 95.5%. The most frequent toxicities were hematologic AEs of grade 3 or higher (68.2% of neutropenia). Cytokine release syndrome occurred in 18 patients (40.9%), with two cases (4.5%) being grade 3. In the follow-up period, 24 patients underwent auto-HSCT after CAR-T within a median of 3 months. The best ORR was 95.5%, with 27 patients (61.4%) achieving CR. The best CR rate was higher in patients receiving CAR-T followed by auto-HSCT compared to those receiving CAR-T alone (75% vs. 45%). 3-year OS and PFS rates for all patients were 79.0% (95%CI, 66.1%-91.9%) and 74.2% (95%CI, 60.3% -88.1%). Patients receiving consolidated auto-HSCT following CAR-T exhibited significantly longer OS and PFS compared to those treated with CAR-T alone. CONCLUSION: Third-generation anti-CD30 CAR-T demonstrates high efficacy and a favorable safety profile in r/r CD30+ lymphoma patients. Addition of auto-HSCT following CAR T-cell therapy improves depth of remission and potentially enhances OS and PFS.
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