摘要
目的研究嵌合抗原受体T细胞(CAR-T)细胞治疗桥接异基因造血干细胞移植(allo-HSCT)治疗复发/难治急性B淋巴细胞白血病(R/R B-ALL)的疗效及安全性。方法回顾性分析2017年1月至2019年5月于苏州大学附属第一医院行CAR-T细胞治疗桥接allo-HSCT的50例R/R B-ALL患者的临床资料,分析CAR-T细胞治疗前、后及allo-HSCT前不同骨髓微小残留病(MRD)水平患者总生存(OS)率、无事件生存(EFS)率、累积复发率(CIR)、移植相关死亡率(TRM)。结果全部患者共行55例次CAR-T细胞治疗,CAR-T细胞治疗反应率、严重细胞因子释放综合征(CRS)发生率分别为92%、28%。未发生治疗相关死亡。CAR-T细胞输注至allo-HSCT的中位时间为54(26~232)d。CAR-T细胞输注后中位随访637(117~1097)d,1年OS、EFS率分别为(80.0±5.7)%、(60.0±6.9)%。移植后1年CIR、TRM分别为(28.0±0.4)%、(8.0±0.2)%。CAR-T细胞输注后及allo-HSCT前骨髓MRD<0.01%患者1年EFS率更高[(70.0±7.2)%、(20.0±12.6)%,P<0.001;(66.7±7.5)%对(36.4±14.5)%,P=0.008],CIR更低[(25.0±0.5)%、(70.0±2.6)%,P<0.001;(23.1±0.5)%、(45.4±2.6)%,P=0.038]。结论CAR-T细胞治疗桥接allo-HCT对于复发/难治B-ALL是一种安全有效的治疗策略。
Objective This study aims to investigate the efficacy and safety of chimeric antigen receptor(CAR)T-cell bridging allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of recurrent and refractory acute B-lymphocytic leukemia(R/R B-ALL).Methods A total of 50 R/R B-ALL patients who underwent CAR T-scell therapy to bridge allo-HSCT in the First Affiliated Hospital of Soochow University from January 2017 to May 2019 were retrospectively analyzed.The overall survival(OS)rate,event-free survival(EFS)rate,cumulative recurrence rate(CIR),and transplant-related mortality(TRM)of patients with different bone marrow minimal residual disease(MRD)levels were analyzed before and after CAR T-cell infusion and before allo-HSCT.Results The response rate of CAR T-cell therapy and the incidence rate of severe cytokine release syndrome were 92%and 28%,respectively.During 55 infusions,no treatment-related deaths occurred in any of the patients.The median time of CAR T-cell infusion to allo-HSCT was 54(26-232)days,the median follow-up time after CAR T-cell infusion was 637(117-1097)days,and the 1-year OS and EFS rates were(80.0±5.7)%and(60.0±6.9)%.The 1-year CIR and TRM after allo-HSCT were(28.0±0.4)%and(8.0±0.2)%.After CAR T-cell infusion and before allo-HSCT,patients with bone marrow MRD<0.01%had a significantly longer EFS[(70.0±7.2)%vs(20.0±12.6)%,P<0.001;(66.7±7.5)%vs(36.4±14.5)%,P=0.008]and lower CIR[(25.0±0.5)%vs(70.0±2.6)%,P<0.001;(23.08±0.47)%vs(45.45±2.60)%,P=0.038].Conclusion CAR T-cell therapy bridging allo-HSCT is safe and effective for recurrent and refractory B-ALL.
作者
闫梦
吴艳珺
陈峰
唐晓文
韩悦
仇惠英
孙爱宁
薛胜利
金正明
王荧
苗瞄
吴德沛
Yan Meng;Wu Yanjun;Chen Feng;Tang Xiaowen;Han Yue;Qiu Huiying;Sun Aining;Xue Shengli;Jin Zhengming;Wang Ying;Miao Miao;Wu Depei(Jiangsu Institute of Hematology,National Clinical Research Center for Hematologic Diseases,NHC Key Laboratory of Thrombosis and Hemostasis,The First Affiliated Hospital of Soochow University,Collaborative Innovation Center of Hematology,State Key Laboratory of Radiation Medicine and Protection,Soochow University,Suzhou 215123,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2020年第9期710-715,共6页
Chinese Journal of Hematology
基金
江苏省科教强卫工程-临床医学中心资助项目(YXZXA2016002)
江苏省高等学校重点学科建设项目(PAPD)。
关键词
嵌合抗原受体
难治
复发
白血病
异基因造血干细胞移植
Chimeric antigen receptors
Relapsed
Refractory
Leukemia
Allogeneic hematopoietic stem cell transplantation