Efficacy and safety of CD19-specific CAR T cell-based therapy in B-cell acute lymphoblastic leukemia patients with CNSL.

Abstract

Few studies have described chimeric antigen receptor (CAR) T-cell therapy for patients with B-cell acute lymphoblastic leukemia (B-ALL) with central nervous system leukemia (CNSL) because of concerns regarding poor response and treatment-related neurotoxicity. Our study included 48 patients with relapsed/refractory B-ALL with CNSL to evaluate the efficacy and safety of CD19-specific CAR T cell-based therapy. The infusion resulted in an overall response rate of 87.5% (95% confidence interval [CI], 75.3-94.1) in bone marrow (BM) disease and remission rate of 85.4% (95% CI, 72.8-92.8) in CNSL. With a median follow-up of 11.5 months (range, 1.3-33.3), the median event-free survival was 8.7 months (95% CI, 3.7-18.8), and the median overall survival was 16.0 months (95% CI, 13.5-20.1). The cumulative incidences of relapse in BM and CNS diseases were 31.1% and 11.3%, respectively, at 12 months (P = .040). The treatment was generally well tolerated, with 9 patients (18.8%) experiencing grade ≥3 cytokine release syndrome. Grade 3 to 4 neurotoxic events, which developed in 11 patients (22.9%), were associated with a higher preinfusion disease burden in CNS and were effectively controlled under intensive management. Our results suggest that CD19-specific CAR T cell-based therapy can induce similar high response rates in both BM and CNS diseases. The duration of remission in CNSL was longer than that in BM disease. CD19 CAR T-cell therapy may provide a potential treatment option for previously excluded patients with CNSL, with manageable neurotoxicity. The clinical trials were registered at www.clinicaltrials.gov as #NCT02782351 and www.chictr.org.cn as #ChiCTR-OPN-16008526.

• Authors: Yuekun Qi, Mingfeng Zhao, Yongxian Hu, Ying Wang, Ping Li, Jiang Cao, Ming Shi, Jiaqi Tan, Meng Zhang, Xia Xiao, Jieyun Xia, Sha Ma, Jianlin Qiao, Zhiling Yan, Hujun Li, Bin Pan, Wei Sang, Depeng Li, Zhenyu Li, Jianfeng Zhou, He Huang, Aibin Liang, Junnian Zheng, Kailin Xu
• Journal: Blood (Blood) Vol. 139 Issue 23 Pg. 3376-3386 (06 09 2022) ISSN: 1528-0020 [Electronic] United States
• PMID: 35338773 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2022 by The American Society of Hematology.

Chemical References

• Antigens, CD19
• Receptors, Chimeric Antigen

Topics

• Acute Disease
• Antigens, CD19
• Burkitt Lymphoma (drug therapy)
• Central Nervous System Neoplasms (drug therapy)
• Cytokine Release Syndrome
• Humans
• Immunotherapy, Adoptive (adverse effects, methods)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma
• Receptors, Chimeric Antigen (therapeutic use)
• T-Lymphocytes