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序贯 CD19 和 BCMA 特异性 CAR T 细胞治疗可引发复发和/或难治性骨髓瘤的持续缓解。

Sequential CD19 and BCMA-specific CAR T-cell treatment elicits sustained remission of relapsed and/or refractory myeloma.

机构信息

The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China.

Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.

出版信息

Cancer Med. 2021 Jan;10(2):563-574. doi: 10.1002/cam4.3624. Epub 2020 Dec 23.


DOI:10.1002/cam4.3624
PMID:33356013
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7877347/
Abstract

The low rate of durable response against relapsed and/or refractory multiple myeloma (RRMM) in recent studies indicates that chimeric antigen receptor T-cell (CART) treatment is yet to be optimized. This study aims to investigate the safety and efficacy of sequential infusion of CD19-CART and B-cell maturation antigen (BCMA)-CARTs for RRMM with a similar 3 + 3 dose escalation combined with a toxicity sentinel design. We enrolled 10 patients, among whom 7 received autologous infusion and 3 received allogeneic infusion. The median follow-up time was 20 months. The most common grade 3/4 treatment-emergent toxicities were hematological toxicities. Cytokine-release syndrome (CRS) adverse reactions were grade 1/2 in 9 out of 10 subjects. No dose-limited toxicity (DLT) was observed for BCMA-CAR-positive T cells ≤5 × 10 /kg), while two patients with dose-levels of 5-6.5 × 10 /kg experienced DLTs. The overall response rate was 90% (five partial responses and four stringent complete responses). Three out of four patients with stringent complete responses to autologous CART had progression-free survival for over 2 years. The three patients with allogeneic CART experienced disease progression within 2 months. These results evidence the sequential infusion's preliminarily tolerability and efficacy in RRMM, and present a simple and safe design applicable for the establishment of multiple CART therapy.

摘要

在最近的研究中,复发和/或难治性多发性骨髓瘤(RRMM)患者对嵌合抗原受体 T 细胞(CART)治疗的持久反应率较低,这表明 CART 治疗仍有待优化。本研究旨在探讨 CD19-CART 和 B 细胞成熟抗原(BCMA)-CART 序贯输注治疗 RRMM 的安全性和有效性,采用相似的 3+3 剂量递增方案,并结合毒性监测设计。我们纳入了 10 例患者,其中 7 例接受了自体输注,3 例接受了异基因输注。中位随访时间为 20 个月。最常见的 3/4 级治疗相关不良事件为血液学毒性。10 例患者中有 9 例发生了 1/2 级细胞因子释放综合征(CRS)不良反应。BCMA-CAR 阳性 T 细胞≤5×10 /kg)时未观察到剂量限制毒性(DLT),而 2 例剂量水平为 5-6.5×10 /kg 的患者发生了 DLT。总缓解率为 90%(5 例部分缓解,4 例严格完全缓解)。4 例自体 CART 严格完全缓解的患者中有 3 例无进展生存期超过 2 年。3 例接受异基因 CART 的患者在 2 个月内疾病进展。这些结果初步证明了 RRMM 序贯输注的耐受性和疗效,并提出了一种简单安全的设计,适用于建立多种 CART 治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/5bdf3cb02448/CAM4-10-563-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/b1fe1dc225e5/CAM4-10-563-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/640d6a8cc1c8/CAM4-10-563-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/2f31699cc76e/CAM4-10-563-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/5bdf3cb02448/CAM4-10-563-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/b1fe1dc225e5/CAM4-10-563-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/640d6a8cc1c8/CAM4-10-563-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/2f31699cc76e/CAM4-10-563-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82cf/7877347/5bdf3cb02448/CAM4-10-563-g004.jpg

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[1]
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[2]
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[3]
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Front Med (Lausanne). 2025-1-22

[4]
Targeting BCMA in multiple myeloma: designs, challenges, and future directions.

Cancer Immunol Immunother. 2025-2-1

[5]
A systematic review on the epidemiology and treatment options of multiple Myeloma in Asia.

Heliyon. 2024-10-22

[6]
Updates on CAR T cell therapy in multiple myeloma.

Biomark Res. 2024-9-12

[7]
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[8]
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[9]
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[10]
Clinical efficacy and safety of combined anti-BCMA and anti-CD19 CAR-T cell therapy for relapsed/refractory multiple myeloma: a systematic review and meta-analysis.

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本文引用的文献

[1]
A combination of humanised anti-CD19 and anti-BCMA CAR T cells in patients with relapsed or refractory multiple myeloma: a single-arm, phase 2 trial.

Lancet Haematol. 2019-10

[2]
Anti-BCMA CAR T-Cell Therapy bb2121 in Relapsed or Refractory Multiple Myeloma.

N Engl J Med. 2019-5-2

[3]
Exploratory trial of a biepitopic CAR T-targeting B cell maturation antigen in relapsed/refractory multiple myeloma.

Proc Natl Acad Sci U S A. 2019-4-15

[4]
Definition of a multiple myeloma progenitor population in mice driven by enforced expression of XBP1s.

JCI Insight. 2019-4-4

[5]
B cell maturation antigen-specific CAR T cells are clinically active in multiple myeloma.

J Clin Invest. 2019-3-21

[6]
A phase 1, open-label study of LCAR-B38M, a chimeric antigen receptor T cell therapy directed against B cell maturation antigen, in patients with relapsed or refractory multiple myeloma.

J Hematol Oncol. 2018-12-20

[7]
T Cells Genetically Modified to Express an Anti-B-Cell Maturation Antigen Chimeric Antigen Receptor Cause Remissions of Poor-Prognosis Relapsed Multiple Myeloma.

J Clin Oncol. 2018-5-29

[8]
Anti-CD19 CAR T cells with high-dose melphalan and autologous stem cell transplantation for refractory multiple myeloma.

JCI Insight. 2018-4-19

[9]
TCR engagement negatively affects CD8 but not CD4 CAR T cell expansion and leukemic clearance.

Sci Transl Med. 2017-11-22

[10]
Regulatory B cell-myeloma cell interaction confers immunosuppression and promotes their survival in the bone marrow milieu.

Blood Cancer J. 2017-3-24

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