Chimeric Antigen Receptor T Cells for Sustained Remissions in Leukemia
Autor: | Anne Chew, David M. Barrett, Yolanda D. Mahnke, Bruce L. Levine, Noelle Frey, David L. Porter, Pamela A. Shaw, J. Joseph Melenhorst, Carl H. June, Zhaohui Zheng, Susan R. Rheingold, Nancy Bunin, Shannon L. Maude, Vanessa E. Gonzalez, David T. Teachey, Stephan A. Grupp, Simon F. Lacey, Angela Shen, Richard Aplenc |
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Rok vydání: | 2014 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent T-Lymphocytes Antigens CD19 Genetic Vectors Receptors Antigen T-Cell Antibodies Monoclonal Humanized Gastroenterology Young Adult chemistry.chemical_compound Tocilizumab Recurrence Internal medicine Humans Medicine Child Survival rate Chimera business.industry Lentivirus Remission Induction Genetic Therapy General Medicine Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Survival Rate Transplantation Cytokine release syndrome Leukemia medicine.anatomical_structure chemistry Child Preschool Immunology Cytokines Female Blinatumomab Chimeric Antigen Receptor T-Cell Therapy Immunotherapy Bone marrow Genetic Engineering business medicine.drug |
Zdroj: | New England Journal of Medicine. 371:1507-1517 |
ISSN: | 1533-4406 0028-4793 |
Popis: | Relapsed acute lymphoblastic leukemia (ALL) is difficult to treat despite the availability of aggressive therapies. Chimeric antigen receptor-modified T cells targeting CD19 may overcome many limitations of conventional therapies and induce remission in patients with refractory disease.We infused autologous T cells transduced with a CD19-directed chimeric antigen receptor (CTL019) lentiviral vector in patients with relapsed or refractory ALL at doses of 0.76×10(6) to 20.6×10(6) CTL019 cells per kilogram of body weight. Patients were monitored for a response, toxic effects, and the expansion and persistence of circulating CTL019 T cells.A total of 30 children and adults received CTL019. Complete remission was achieved in 27 patients (90%), including 2 patients with blinatumomab-refractory disease and 15 who had undergone stem-cell transplantation. CTL019 cells proliferated in vivo and were detectable in the blood, bone marrow, and cerebrospinal fluid of patients who had a response. Sustained remission was achieved with a 6-month event-free survival rate of 67% (95% confidence interval [CI], 51 to 88) and an overall survival rate of 78% (95% CI, 65 to 95). At 6 months, the probability that a patient would have persistence of CTL019 was 68% (95% CI, 50 to 92) and the probability that a patient would have relapse-free B-cell aplasia was 73% (95% CI, 57 to 94). All the patients had the cytokine-release syndrome. Severe cytokine-release syndrome, which developed in 27% of the patients, was associated with a higher disease burden before infusion and was effectively treated with the anti-interleukin-6 receptor antibody tocilizumab.Chimeric antigen receptor-modified T-cell therapy against CD19 was effective in treating relapsed and refractory ALL. CTL019 was associated with a high remission rate, even among patients for whom stem-cell transplantation had failed, and durable remissions up to 24 months were observed. (Funded by Novartis and others; CART19 ClinicalTrials.gov numbers, NCT01626495 and NCT01029366.). |
Databáze: | OpenAIRE |
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