文章：

对于难治性/复发性急性B细胞淋巴细胞白血病，哪种更好：单靶点（CD19）还是双靶点（串联或序贯CD19/CD22）CAR T细胞疗法？

Which one is better for refractory/relapsed acute B-cell lymphoblastic leukemia: Single-target (CD19) or dual-target (tandem or sequential CD19/CD22) CAR T-cell therapy?

原文发布日期：2023-04-24

DOI: 10.1038/s41408-023-00819-5

类型: Article

开放获取: 是

英文摘要：

CD19 chimeric antigen receptor (CAR) T-cell therapy has shown great success against B-cell acute lymphoblastic leukemia (B-ALL). Tandem and sequential CD19/CD22 dual-target CAR T-cell therapies have been developed to reduce the possibility of CD19-negative relapse; however, the superior strategy is still uncertain. This study screened 219 patients with relapsed/refractory B-ALL who were enrolled in clinical trials of either CD19 (NCT03919240) or CD19/CD22 CAR T-cell therapy (NCT03614858). The complete remission (CR) rates in the single CD19, tandem CD19/CD22, and sequential CD19/CD22 groups were 83.0% (122/147), 98.0% (50/51), and 95.2% (20/21), respectively (single CD19 vs. tandem CD19/CD22, P = 0.006). Patients with high-risk factors achieved a higher rate of CR in the tandem CD19/CD22 group than in the single CD19 group (100.0% vs. 82.4%, P = 0.017). Tandem CD19/CD22 CAR T-cell therapy was one of the significant favorable factors in the multivariate analysis of the CR rate. The incidence of adverse events was similar among the three groups. Multivariable analysis in CR patients showed that a low frequency of relapse, a low tumor burden, minimal residual disease-negative CR and bridging to transplantation were independently associated with better leukemia-free survival. Our findings suggested that tandem CD19/CD22 CAR T-cell therapy obtains a better response than CD19 CAR T-cell therapy and a similar response to sequential CD19/CD22 CAR T-cell therapy.
 

摘要翻译： 

CD19嵌合抗原受体T细胞疗法在治疗B细胞急性淋巴细胞白血病方面已取得显著成功。为降低CD19阴性复发的可能性，串联式及序贯式CD19/CD22双靶点CAR-T疗法相继问世，但其最优策略仍未明确。本研究筛选了219例参与CD19单靶点（临床试验号NCT03919240）或CD19/CD22双靶点CAR-T疗法（临床试验号NCT03614858）的复发/难治性B-ALL患者。结果显示：单靶点CD19组、串联CD19/CD22组及序贯CD19/CD22组的完全缓解率分别为83.0%（122/147）、98.0%（50/51）和95.2%（20/21）（单靶点CD19组与串联CD19/CD22组比较，P=0.006）。对于存在高危因素的患者，串联CD19/CD22组的完全缓解率显著高于单靶点CD19组（100.0%对比82.4%，P=0.017）。多因素分析表明串联CD19/CD22 CAR-T疗法是显著影响完全缓解率的有利因素之一。三组间不良事件发生率相近。对获得完全缓解的患者进行多因素分析发现，低复发频率、低肿瘤负荷、微小残留病灶阴性完全缓解以及桥接移植治疗与更佳的无白血病生存期独立相关。本研究提示，串联CD19/CD22 CAR-T疗法较单靶点CD19疗法具有更优疗效，且与序贯CD19/CD22疗法疗效相当。

原文链接：

Which one is better for refractory/relapsed acute B-cell lymphoblastic leukemia: Single-target (CD19) or dual-target (tandem or sequential CD19/CD22) CAR T-cell therapy?