Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France.
Université Paris Cité, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Centre MEARY de Thérapie Cellulaire et Génique, Paris, France.
Blood Adv. 2024 Jan 23;8(2):337-342. doi: 10.1182/bloodadvances.2023011992.
Chimeric antigen receptor (CAR) T-cell therapies have shown significant benefits in the treatment of hematologic malignancies, such as B-cell acute lymphoblastic leukemia (B-ALL) and B-cell lymphoma. Despite the therapeutic advances offered by these innovative treatments, failures are still observed in 15% to 40% of patients with B-ALL and >50% of patients with B-cell lymphoma. Several hypotheses have emerged including CD19-negative or -positive relapses, low CAR T-cell activation and/or expansion in vivo, or T-cell exhaustion. To date, in the European Union, CAR T cells granted with marketing authorization are autologous and thus associated with a strong heterogeneity between products. Indeed, the manufacturing of a single batch requires cellular starting material collection by apheresis for each patient, with variable cellular composition, and then challenging pharmaceutical companies to standardize as much as possible the production process. In addition, these cost and time-consuming therapies are associated with a risk of manufacturing failure reaching 25%. Thus, there is a growing need to identify early risk factors of unsuccessful production and/or therapeutic escape. Quality of the apheresis product, pathology progression, as well as previous treatments have been reported as predictive factors of the variability in clinical response. The aim of this review is to report and discuss predictive factors that could help to anticipate the manufacturing success and clinical response.
嵌合抗原受体 (CAR) T 细胞疗法在治疗血液系统恶性肿瘤方面显示出显著的疗效,例如 B 细胞急性淋巴细胞白血病 (B-ALL) 和 B 细胞淋巴瘤。尽管这些创新疗法提供了治疗进展,但仍有 15%至 40%的 B-ALL 患者和 >50%的 B 细胞淋巴瘤患者治疗失败。出现了几种假说,包括 CD19 阴性或阳性复发、CAR T 细胞在体内的低激活和/或扩增,或 T 细胞耗竭。迄今为止,在欧盟,获得营销授权的 CAR T 细胞是自体的,因此产品之间存在很强的异质性。实际上,为每个患者制造单个批次需要通过单采术收集细胞起始材料,其细胞组成具有变异性,然后要求制药公司尽可能标准化生产过程。此外,这些成本高且耗时的疗法与高达 25%的制造失败风险相关。因此,越来越需要确定生产不成功和/或治疗逃逸的早期风险因素。据报道,单采产品的质量、疾病进展以及先前的治疗均为临床反应变异性的预测因素。本综述的目的是报告和讨论有助于预测制造成功和临床反应的预测因素。
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