ABSTRACT
Objective@#To investigate the efficacy and safety of CD19 chimeric antigen receptor T (CAR-T) lymphocytes for the treatment of B cell lymphoma.@*Methods@#A total of 22 patients with B-cell lymphoma from February 1, 2017 to July 1, 2018 were reviewed to evaluate the efficacy and adverse reactions of CD19 CAR-T.@*Results@#Of 22 patients with B-cell lymphoma received CD19 CAR-T cells, the median dose of CAR-T cells was 7.2 (2.0-12.0) ×106/kg. Nine of 12 cases of relapse refractory patients were overall response. Complete remission (CR) occurred in 2 of 12 patients, partial remission (PR) in 7 of 12 patients. The overall response in minor residual disease positive (MRD) group was 8 of 10 patients. CD19 CAR-T cells proliferated in vivo and were detectable in the blood of patients. The peak timepoints of CAR-T cells proliferated in the relapsed refractory and MRD positive groups were 12 (5-19) and 4.5 (1-12) days after treatment respectively, and among peripheral blood cells, CAR-T cells accounted for 10.10% (3.55%-24.74%) and 4.02% (2.23%-28.60%) of T lymphocytes respectively. The MRD positive patients achieved sustained remissions during a median follow-up of 8 months (rang 3-18 months) . None of all the patients relapsed during a median follow-up time of 10 months (3-18 months) . However, 7 PR responders of the relapsed refractory patients maintained a good condition for 1.5-6.0 months. One patient bridged to hematopoietic stem cell transplantation, another one sustained remission for 12 months. Cytokine-release syndrome (CRS) occurred in 14 patients with grade 1-2 CRS in MRD positive group and grade 3 CRS in relapsed refractory group.@*Conclusions@#CAR-T cell therapy not only played a role in the rescue treatment of relapsed and refractory patients, but also produced a surprising effect in the consolidation and maintenance of B-cell lymphoma. CD19 CAR-T cells might be more effective in the treatment of MRD positive B-cell lymphoma patients than in the refractory or relapsed cases. High response rate was observed with fewer adverse reactions.
ABSTRACT
Recent years,chimeric antigen receptor T-cell(CAR-T)therapy has made great strides in enabling better treatment of malig-nant tumors,especially hematological tumors,as well as increasing the research prospects of potential solid tumor therapies.Conse-quently,CAR-T therapy is expected to become the selected treatment for patients with relapsed and refractory tumors.Immune check-point inhibitors also have certain curative effects in the treatment of cancers,such as liver cancer,refractory Hodgkin's lymphoma,and other malignant tumors,which brings promise to patients with advanced cancer.However,both treatments have different degrees of limitations.Recent clinical trials suggest that combined immune checkpoint inhibitors impair the immunosuppressive effects of the tu-mor microenvironment,increase the efficacy of CAR-T therapy,and prolong the survival.This article will review the research progress on the combination of CAR-T immunotherapy and immune checkpoint inhibitors in malignancies theray.