Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX;
Blood. 2013 Oct 24;122(17):2965-73. doi: 10.1182/blood-2013-06-506741. Epub 2013 Sep 12.
Autologous T cells expressing a CD19-specific chimeric antigen receptor (CD19.CAR) are active against B-cell malignancies, but it is unknown whether allogeneic CD19.CAR T cells are safe or effective. After allogeneic hematopoietic stem cell transplantation (HSCT), infused donor-derived virus-specific T cells (VSTs) expand in vivo, persist long term, and display antiviral activity without inducing graft-vs-host disease; therefore, we determined whether donor VSTs, engineered to express CD19.CAR, retained the characteristics of nonmanipulated allogeneic VSTs while gaining antitumor activity. We treated 8 patients with allogeneic (donor-derived) CD19.CAR-VSTs 3 months to 13 years after HSCT. There were no infusion-related toxicities. VSTs persisted for a median of 8 weeks in blood and up to 9 weeks at disease sites. Objective antitumor activity was evident in 2 of 6 patients with relapsed disease during the period of CD19.CAR-VST persistence, whereas 2 patients who received cells while in remission remain disease free. In 2 of 3 patients with viral reactivation, donor CD19.CAR-VSTs expanded concomitantly with VSTs. Hence CD19.CAR-VSTs display antitumor activity and, because their number may be increased in the presence of viral stimuli, earlier treatment post-HSCT (when lymphodepletion is greater and the incidence of viral infection is higher) or planned vaccination with viral antigens may enhance disease control.
自体 T 细胞表达 CD19 特异性嵌合抗原受体(CD19.CAR)可有效对抗 B 细胞恶性肿瘤,但异体 CD19.CAR T 细胞是否安全或有效尚不清楚。异体造血干细胞移植(HSCT)后,输注的供体来源的病毒特异性 T 细胞(VST)在体内扩增,长期持续存在,并表现出抗病毒活性而不引起移植物抗宿主病;因此,我们确定了经基因工程表达 CD19.CAR 的供体 VST 是否保留了未经修饰的异体 VST 的特征,同时获得了抗肿瘤活性。我们在 HSCT 后 3 个月至 13 年内治疗了 8 例异体(供体来源)CD19.CAR-VST 的患者。没有输注相关的毒性。VST 在血液中的中位持续时间为 8 周,在疾病部位的最长持续时间为 9 周。在 CD19.CAR-VST 持续存在期间,有 2 例复发疾病的患者表现出明显的抗肿瘤活性,而在缓解期接受细胞治疗的 2 例患者仍无疾病。在 3 例病毒再激活的患者中,有 2 例患者的供体 CD19.CAR-VST 与 VST 同时扩增。因此,CD19.CAR-VST 具有抗肿瘤活性,并且由于其数量可能在存在病毒刺激时增加,因此更早地进行 HSCT 后治疗(当淋巴细胞耗竭更大且病毒感染的发生率更高时)或计划用病毒抗原进行疫苗接种可能会增强疾病控制。
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