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