摘要
目的:评估难治性弥漫大B细胞淋巴瘤(DLBCL)患者接受自体移植和靶向CD19的嵌合抗原受体T细胞(抗CD19 CAR-T)治疗后的疗效和安全性。方法:纳入7例疾病进展的难治性ⅣB期DLBCL患者进行自体移植,自体干细胞回输后第4天回输自体共刺激因子为4-1BB的抗CD19 CAR-T细胞2.0×10^(6)/kg(1.0×10^(6)/kg~2.6×10^(6)/kg)。结果:中位随访时间186(112~326) d,最佳疗效为3例达完全缓解,4例达部分缓解,总体反应率达100%。其中巨块型的最佳疗效均为部分缓解。随访终点总生存率71.4%,其中巨块型者总生存率66%,非巨块型者总生存率75%。中性粒细胞植入时间17(14~26) d。CAR-T开始扩增的时间与中位粒细胞植入时间呈正相关(r=0.884,P=0.008)。巨块型患者中CAR-T峰值出现的时间较非巨块型者晚(r=0.864,P=0.012)。细胞因子释放综合征发生率28.6%(2/7),无严重细胞因子释放综合征发生。结论:自体移植联合抗CD19 CAR-T方案可作为难治性DLBCL拯救性治疗的方法。
Objective: To evaluate the efficacy and safety of autologous transplantation followed by CD19-targeted chimeric antigen receptor T cells(anti-CD19 CAR-T) therapy for refractory diffuse large B-cell lymphoma(DLBCL). Methods: Seven DLBCL patients with stage ⅣB were enrolled in this study. All the patients showed disease progression after multi-line treatment. Patients underwent autologous transplantation and followed by 2.0×10^(6)/kg(1.0×10^(6)/kg-2.6×10^(6)/kg) 4-1 BB anti-CD19 CAR-T cells on days +4. Results: The median follow-up time was 186(112-326) days. Three of 7 cases achieved a best response of complete remission;4 cases achieved best response of partial remission. The overall response rate reached 100%. Among them, the best curative effect of patients with bulky tumor was partial remission. The overall survival rate was 71.4%, among which 66% in bulky lymphoma and 75% in non-bulky lymphoma. The engraftment time of neutrophils was 17(14-26) days. The time of CAR-T expansion was positively correlated with the median time of neutrophil engraftment(r=0.884, P=0.008). It took longer to reach the peak of CAR-T cell expansion in bulky patients than that in non-bulky patients(r=0.864, P=0.012). Two of 7 cases(28.6%) experienced CAR-T cell-induced cytokine-release syndrome, and no severe cytokine-release syndrome occurred. Conclusion: Autologous transplantation followed by anti-CD19 CAR-T may be a salvage treatment for refractory DLBCL.
作者
蒋瑛
刘慧霞
朱骏
赵初娴
李肃
陈鸿林
王椿
JIANG Ying;LIU Huixia;ZHU Jun;ZHAO Chuxian;LI Su;CHEN Honglin;WANG Chun(Shanghai Zhaxin Integrated Traditional Chinese and Western Medicine Hospital,Shanghai,200435,China)
出处
《临床血液学杂志》
CAS
2021年第11期771-775,共5页
Journal of Clinical Hematology
