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CD19 导向的嵌合抗原受体 T 细胞疗法治疗原发性中枢神经系统淋巴瘤。

CD19-directed CAR T-cell therapy for treatment of primary CNS lymphoma.

机构信息

Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA.

Department of Computational and Quantitative Medicine/Beckman Research Institute, City of Hope Medical Center, Duarte, CA.

出版信息

Blood Adv. 2021 Oct 26;5(20):4059-4063. doi: 10.1182/bloodadvances.2020004106.


DOI:10.1182/bloodadvances.2020004106
PMID:34492703
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8945630/
Abstract

CD19-directed chimeric antigen receptor (CD19CAR) T-cell therapy has been successful in treating several B-cell lineage malignancies, including B-cell non-Hodgkin lymphoma (NHL). This modality has not yet been extended to NHL manifesting in the central nervous system (CNS), primarily as a result of concerns for potential toxicity. CD19CAR T cells administered IV are detectable in cerebrospinal fluid (CSF), suggesting that chimeric antigen receptor (CAR) T cells can migrate from the periphery into the CNS, where they can potentially mediate antilymphoma activity. Here, we report the outcome of a subset of patients with primary CNS lymphoma (PCNSL; n = 5) who were treated with CD19CAR T cells in our ongoing phase 1 clinical trial. All patients developed grade ≥ 1 cytokine release syndrome and neurotoxicity post-CAR T-cell infusion; toxicities were reversible and tolerable, and there were no treatment-related deaths. At initial disease response, 3 of 5 patients (60%; 90% confidence interval, 19-92%) seemed to achieve complete remission, as indicated by resolution of enhancing brain lesions; the remaining 2 patients had stable disease. Although the study cohort was small, we demonstrate that using CD19CAR T cells to treat PCNSL can be safe and feasible. This trial was registered at www.clinicaltrials.gov as #NCT02153580.

摘要

CD19 导向嵌合抗原受体 (CD19CAR) T 细胞疗法已成功治疗多种 B 细胞谱系恶性肿瘤,包括 B 细胞非霍奇金淋巴瘤 (NHL)。这种方法尚未扩展到中枢神经系统 (CNS) 中表现出的 NHL,主要是由于对潜在毒性的担忧。静脉内给予的 CD19CAR T 细胞可在脑脊液 (CSF) 中检测到,这表明嵌合抗原受体 (CAR) T 细胞可以从外周迁移到 CNS,在那里它们可能介导抗淋巴瘤活性。在这里,我们报告了在我们正在进行的 1 期临床试验中接受 CD19CAR T 细胞治疗的一组原发性中枢神经系统淋巴瘤 (PCNSL; n = 5) 患者的结果。所有患者在 CAR T 细胞输注后均出现≥1 级细胞因子释放综合征和神经毒性;毒性是可逆的,可以耐受,没有与治疗相关的死亡。在初始疾病反应时,5 名患者中的 3 名(60%;90%置信区间,19-92%)似乎达到完全缓解,表现为增强的脑部病变消退;其余 2 名患者病情稳定。尽管研究队列规模较小,但我们证明使用 CD19CAR T 细胞治疗 PCNSL 是安全且可行的。该试验在 www.clinicaltrials.gov 上注册为 #NCT02153580。

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本文引用的文献

[1]
The Cerebroventricular Environment Modifies CAR T Cells for Potent Activity against Both Central Nervous System and Systemic Lymphoma.

Cancer Immunol Res. 2021-1

[2]
Single-Cell Analyses Identify Brain Mural Cells Expressing CD19 as Potential Off-Tumor Targets for CAR-T Immunotherapies.

Cell. 2020-10-1

[3]
Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study.

Lancet. 2020-9-1

[4]
Axicabtagene ciloleucel CD19 CAR-T cell therapy results in high rates of systemic and neurologic remissions in ten patients with refractory large B cell lymphoma including two with HIV and viral hepatitis.

J Hematol Oncol. 2020-1-3

[5]
CD19 and CD70 Dual-Target Chimeric Antigen Receptor T-Cell Therapy for the Treatment of Relapsed and Refractory Primary Central Nervous System Diffuse Large B-Cell Lymphoma.

Front Oncol. 2019-12-4

[6]
What a headache! Double-hit lymphoma with CNS recurrence - Role of chimeric antigen receptor (CAR) T-cell therapy.

Leuk Lymphoma. 2020-4

[7]
Tisagenlecleucel in relapsed/refractory diffuse large B-cell lymphoma patients without measurable disease at infusion.

Blood Adv. 2019-7-23

[8]
Tisagenlecleucel CAR T-cell therapy in secondary CNS lymphoma.

Blood. 2019-7-18

[9]
Clinical presentation, management, and biomarkers of neurotoxicity after adoptive immunotherapy with CAR T cells.

Blood. 2019-2-26

[10]
Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma.

N Engl J Med. 2018-12-1

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