嵌合抗原受体T细胞序贯异基因造血干细胞移植治疗Ph样急性淋巴细胞白血病21例的疗效及安全性

Efficacy and safety of chimeric antigen receptor T-cell therapy followed by allogeneic hematopoietic stem cell transplantation in 21 patients with Ph-like acute lymphoblastic leukemia

扫码查看

原文链接

维普
万方数据

中文摘要：目的评估嵌合抗原受体T细胞(CAR-T细胞)序贯异基因造血干细胞移植(allo-HSCT)治疗Ph样急性淋巴细胞白血病(Ph样ALL)患者的疗效及安全性.方法纳入2018年3月至2023年8月在苏州大学附属第一医院接受CAR-T细胞序贯allo-HSCT治疗的21例Ph样ALL患者,对其临床资料进行回顾性分析.结果21例患者中,男14例,女7例.接受CAR-T细胞治疗时的中位年龄为22(6～50)岁.7例为ABL1样重排,14例为JAK-STAT重排.接受CAR-T细胞治疗前,12例为血液学未缓解,7例为多参数流式细胞术微小残留病(MFC-MRD)阳性,2例为MFC-MRD阴性.CAR-T细胞均来自患者自体淋巴细胞.9例接受CD19 CAR-T细胞治疗,12例接受CD19/CD22双靶点CAR-T细胞治疗.CAR-T细胞治疗后28 d评估,完全缓解率为95.2％,其中MFC-MRD阴性缓解率75.0％.19例患者出现0～2级细胞因子释放综合征(CRS),2例患者出现3级CRS,经治疗后均恢复.所有患者CAR-T细胞治疗后均接受allo-HSCT.CAR-T细胞治疗后桥接移植的中位时间为63(38～114)d.5例患者CAR-T细胞治疗后出现复发,4例为血液学复发,1例为分子学复发.ABL1组和JAK-STAT组患者的3年总生存率分别为(83.3±15.2)％和(66.6±17.2)％,3年无复发生存率分别为(50.0±20.4)％和(55.6±15.4)％,差异均无统计学意义(P值均＞0.05).结论CAR-T细胞桥接allo-HSCT,能使大部分Ph样ALL患者迅速达到深度缓解,显著延长患者的无白血病生存.

外文摘要：Objective To evaluate the efficacy and safety of chimeric antigen receptor T-cell(CAR-T)therapy followed by allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with Ph-like acute lymphoblastic leukemia(Ph-ALL).Methods Patients with Ph-ALL who underwent CAR-T therapy followed by allo-HSCT from March 2018 to August 2023 at the First Affiliated Hospital of Soochow University were included,and their clinical data were retrospectively analyzed.Results Of the 21 patients,14 were male and 7 were female.The median age at the time of CAR-T therapy was 22(6-50)years.Seven patients had ABLl-like rearrangements,and 14 had JAK-STAT rearrangements.Prior to CAR-T therapy,12 patients experienced hematologic relapse;7 were multiparameter flow cytometry minimal residual disease(MFC-MRD)-positive and 2 were MFC-MRD-negative.CAR-T cells were derived from patients'autologous lymphocytes.Nine patients were treated with CD 19 CAR-T cells,and 12 were treated with CD19/CD22 CAR-T cells.After assessment on day 28 after CAR-T therapy,95.2％of the patients achieved complete remission,with an MRD-negative remission rate of 75％.Nineteen patients developed grade 0-2 cytokine release syndrome(CRS)and 2 patients suffered grade 3 CRS,all cases of which resolved after treatment.All patients underwent allo-HSCT after CAR-T therapy.The median time from CAR-T therapy to allo-HSCT was 63(38-114)days.Five patients experienced relapse after CAR-T therapy,including four with hematologic relapse and one with molecular relapse.The 3-year overall survival(OS)rates in the ABL1 and JAK-STAT groups were(83.3±15.2)％and(66.6±17.2)％,respectively(P=0.68).The 3-year relapse-free survival(RFS)rates were(50.0±20.4)％and(55.6± 15.4)％in the ABL1 and JAK-STAT groups,respectively.There was no significant difference in 3-year OS or RFS between the two groups.Conclusions CAR-T therapy followed by allo-HSCT leads to rapid remission in most patients with Ph-ALL and prolongs leukemia-free survival.

外文关键词：

Chimeric antigen T cellallogenic hematopoietic stem cell transplantationPh-likeAcute lymphoblastic leukemia

作者：

戴海萍、沈宏杰、李正、崔巍、崔庆亚、郦梦云、陈思帆、朱明清、吴德沛、唐晓文

展开 >

作者单位：

苏州大学附属第一医院血液内科,国家血液系统疾病临床医学研究中心,江苏省血液研究所,血液学协同创新中心,苏州大学造血干细胞移植研究所,苏州 215006

关键词：

嵌合抗原受体T细胞异基因造血干细胞移植 Ph样白血病,淋巴细胞,急性

基金：

国家自然科学基金国家血液系统疾病临床医学研究中心转化研究课题江苏省自然科学基金江苏省卫生健康委重点项目苏州市科技计划(医疗卫生科技创新)临床前沿技术项目白求恩血液科研能力建设项目苏州市临床重点病种诊疗技术专项中华国际医学交流基金会项目

项目编号：

820701622020ZKZC04BK20201169K2019022SKY2022001BCF-IBW-XY-20220930-13LCZX202201Z-2018-31-2102-4

出版年：

2024

DOI：

10.3760/cma.j.cn121090-20230929-00154

中华血液学杂志

中华医学会

中华血液学杂志

CSTPCD北大核心

影响因子：1.17

ISSN：0253-2727

年,卷(期)：2024.45(1)

参考文献量22