Huang Wei-Han, Tong Chun-Rong, Wu Tong, Lin Yun-Chu, Li Chi-Cheng
Department of Clinical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Department of Hematology & Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Blood Cell Ther. 2020 Aug 4;3(4):71-73. doi: 10.31547/bct-2020-002. eCollection 2020 Nov 25.
Precursor B-cell acute lymphoblastic leukemia (pre-B ALL) relapse after allogeneic hematopoietic stem cell transplantation (HSCT) typically has poor outcomes. Both bispecific T-cell engager (BiTE, blinatumomab) and chimeric antigen receptor T-cell (CAR-T) are novel immuno-designed therapies for advanced acute lymphoblastic leukemia. However, the treatment and effects of their combination remain unclear. Two patients with pre-B ALL experienced overt leukemic relapse after allogeneic HSCT. Both patients received one standard cycle of blinatumomab treatment, and complete remission was achieved. Subsequently, during remission, both patients underwent treatment with CAR-T cells prepared from their own T-cells. One patient received CD22-CAR-T cell as a consolidative therapy, while the other underwent CD19-CAR-T cell therapy. No cytokine release syndrome occurred. After treatment, both patients are alive and do not have leukemia recurrence for more than one year. In conclusion, sequential combination of BiTE followed by CAR-T cell therapy may show promising results for relapsed and advanced B-cell leukemia. This novel combination is worthy of further investigation.
前体B细胞急性淋巴细胞白血病（pre-B ALL）在异基因造血干细胞移植（HSCT）后复发，通常预后较差。双特异性T细胞衔接器（BiTE，博纳吐单抗）和嵌合抗原受体T细胞（CAR-T）都是用于晚期急性淋巴细胞白血病的新型免疫设计疗法。然而，它们联合使用的治疗方法和效果仍不明确。两名pre-B ALL患者在异基因HSCT后出现明显的白血病复发。两名患者均接受了一个标准疗程的博纳吐单抗治疗，并实现了完全缓解。随后，在缓解期，两名患者均接受了用自身T细胞制备的CAR-T细胞治疗。一名患者接受CD22-CAR-T细胞作为巩固治疗，另一名患者接受CD19-CAR-T细胞治疗。未发生细胞因子释放综合征。治疗后，两名患者均存活，且一年多未出现白血病复发。总之，BiTE序贯CAR-T细胞疗法可能对复发和晚期B细胞白血病显示出有前景的结果。这种新型联合疗法值得进一步研究。
