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