Phase I study of CBM.CD19 chimeric antigen receptor T cell in the treatment of refractory diffuse large B-cell lymphoma in Chinese patients
Lei Fan, Li Wang, Lei Cao, Huayuan Zhu, Wei Xu(), Jianyong Li()
Department of Hematology, Pukou CLL Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
Anti-CD19 chimeric antigen receptor (CAR) T cell therapy has shown impressive efficacy in treating B-cell malignancies. A single-center phase I dose-escalation study was conducted to evaluate the safety and efficacy of T cells transduced with CBM.CD19 CAR, a second-generation anti-CD19 CAR bearing 4-1BB costimulatory molecule, for the treatment of patients with refractory diffuse large B-cell lymphoma (DLBCL). Ten heavily treated patients with refractory DLBCL were given CBM.CD19 CAR-T cell (C-CAR011) treatment. The overall response rate was 20% and 50% at 4 and 12 weeks after the infusion of C-CAR011, respectively, and the disease control rate was 60% at 12 weeks after infusion. Treatment-emergent adverse events occurred in all patients. The incidence of cytokine release syndrome in all grades and grade≥3 was 90% and 0, respectively, which is consistent with the safety profile of axicabtagene ciloleucel and tisagenlecleucel. Neurotoxicity or other dose-limiting toxicities was not observed in any dose cohort of C-CAR011 therapy. Antitumor efficacy was apparent across dose cohorts. Therefore, C-CAR011 is a safe and effective therapeutic option for Chinese patients with refractory DLBCL, and further large-scale clinical trials are warranted.
Peng Lu, Renxing Wang, and Yue Xing contributed equally to this work.
引用本文:
. [J]. Frontiers of Medicine, 2022, 16(2): 285-294.
Lei Fan, Li Wang, Lei Cao, Huayuan Zhu, Wei Xu, Jianyong Li. Phase I study of CBM.CD19 chimeric antigen receptor T cell in the treatment of refractory diffuse large B-cell lymphoma in Chinese patients. Front. Med., 2022, 16(2): 285-294.
LH Sehn, RD Gascoyne. Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity. Blood 2015; 125(1): 22–32 https://doi.org/10.1182/blood-2014-05-577189
pmid: 25499448
2
E Van Den Neste, N Schmitz, N Mounier, D Gill, D Linch, M Trneny, N Milpied, J Radford, N Ketterer, O Shpilberg, U Dührsen, D Ma, J Brière, C Thieblemont, G Salles, CH Moskowitz, B Glass, C Gisselbrecht. Outcome of patients with relapsed diffuse large B-cell lymphoma who fail second-line salvage regimens in the International CORAL study. Bone Marrow Transplant 2016; 51(1): 51–57 https://doi.org/10.1038/bmt.2015.213
pmid: 26367239
3
C Gisselbrecht, B Glass, N Mounier, D Singh Gill, DC Linch, M Trneny, A Bosly, N Ketterer, O Shpilberg, H Hagberg, D Ma, J Brière, CH Moskowitz, N Schmitz. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol 2010; 28(27): 4184–4190 https://doi.org/10.1200/JCO.2010.28.1618
pmid: 20660832
4
SJ Nagle, K Woo, SJ Schuster, SD Nasta, E Stadtmauer, R Mick, J Svoboda. Outcomes of patients with relapsed/refractory diffuse large B-cell lymphoma with progression of lymphoma after autologous stem cell transplantation in the rituximab era. Am J Hematol 2013; 88(10): 890–894 https://doi.org/10.1002/ajh.23524
pmid: 23813874
5
M Crump, SS Neelapu, U Farooq, E Van Den Neste, J Kuruvilla, J Westin, BK Link, A Hay, JR Cerhan, L Zhu, S Boussetta, L Feng, MJ Maurer, L Navale, J Wiezorek, WY Go, C Gisselbrecht. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood 2017; 130(16): 1800–1808 https://doi.org/10.1182/blood-2017-03-769620
pmid: 28774879
6
DL Porter, BL Levine, M Kalos, A Bagg, CH June. Chimeric antigen receptor-modified T cells in chronic lymphoid leukemia. N Engl J Med 2011; 365(8): 725–733 https://doi.org/10.1056/NEJMoa1103849
pmid: 21830940
7
CJ Turtle, KA Hay, LA Hanafi, D Li, S Cherian, X Chen, B Wood, A Lozanski, JC Byrd, S Heimfeld, SR Riddell, DG Maloney. Durable molecular remissions in chronic lymphocytic leukemia treated with CD19-specific chimeric antigen receptor-modified T cells after failure of ibrutinib. J Clin Oncol 2017; 35(26): 3010–3020 https://doi.org/10.1200/JCO.2017.72.8519
pmid: 28715249
8
SL Maude, N Frey, PA Shaw, R Aplenc, DM Barrett, NJ Bunin, A Chew, VE Gonzalez, Z Zheng, SF Lacey, YD Mahnke, JJ Melenhorst, SR Rheingold, A Shen, DT Teachey, BL Levine, CH June, DL Porter, SA Grupp. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med 2014; 371(16): 1507–1517 https://doi.org/10.1056/NEJMoa1407222
pmid: 25317870
9
SL Maude, TW Laetsch, J Buechner, S Rives, M Boyer, H Bittencourt, P Bader, MR Verneris, HE Stefanski, GD Myers, M Qayed, B De Moerloose, H Hiramatsu, K Schlis, KL Davis, PL Martin, ER Nemecek, GA Yanik, C Peters, A Baruchel, N Boissel, F Mechinaud, A Balduzzi, J Krueger, CH June, BL Levine, P Wood, T Taran, M Leung, KT Mueller, Y Zhang, K Sen, D Lebwohl, MA Pulsipher, SA Grupp. Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia. N Engl J Med 2018; 378(5): 439–448 https://doi.org/10.1056/NEJMoa1709866
pmid: 29385370
10
JN Kochenderfer, ME Dudley, SH Kassim, RP Somerville, RO Carpenter, M Stetler-Stevenson, JC Yang, GQ Phan, MS Hughes, RM Sherry, M Raffeld, S Feldman, L Lu, YF Li, LT Ngo, A Goy, T Feldman, DE Spaner, ML Wang, CC Chen, SM Kranick, A Nath, DA Nathan, KE Morton, MA Toomey, SA Rosenberg. Chemotherapy-refractory diffuse large B-cell lymphoma and indolent B-cell malignancies can be effectively treated with autologous T cells expressing an anti-CD19 chimeric antigen receptor. J Clin Oncol 2015; 33(6): 540–549 https://doi.org/10.1200/JCO.2014.56.2025
pmid: 25154820
11
JN Kochenderfer, RPT Somerville, T Lu, V Shi, A Bot, J Rossi, A Xue, SL Goff, JC Yang, RM Sherry, CA Klebanoff, US Kammula, M Sherman, A Perez, CM Yuan, T Feldman, JW Friedberg, MJ Roschewski, SA Feldman, L McIntyre, MA Toomey, SA Rosenberg. Lymphoma remissions caused by anti-CD19 chimeric antigen receptor T cells are associated with high serum interleukin-15 levels. J Clin Oncol 2017; 35(16): 1803–1813 https://doi.org/10.1200/JCO.2016.71.3024
pmid: 28291388
12
FL Locke, A Ghobadi, CA Jacobson, DB Miklos, LJ Lekakis, OO Oluwole, Y Lin, I Braunschweig, BT Hill, JM Timmerman, A Deol, PM Reagan, P Stiff, IW Flinn, U Farooq, A Goy, PA McSweeney, J Munoz, T Siddiqi, JC Chavez, AF Herrera, NL Bartlett, JS Wiezorek, L Navale, A Xue, Y Jiang, A Bot, JM Rossi, JJ Kim, WY Go, SS Neelapu. Long-term safety and activity of axicabtagene ciloleucel in refractory large B-cell lymphoma (ZUMA-1): a single-arm, multicentre, phase 1–2 trial. Lancet Oncol 2019; 20(1): 31–42 https://doi.org/10.1016/S1470-2045(18)30864-7
pmid: 30518502
13
J Abramson, L Gordon, M Palomba, M Lunning, J Arnason, A Forero-Torres, M Wang, D Maloney, A Sehgal, C Andreadis, E Purev, SR Solomon, N Ghosh, TM Albertson, B Xie, J Garcia, T Siddiqi. Updated safety and long term clinical outcomes in TRANSCEND NHL 001, pivotal trial of lisocabtagene maraleucel (JCAR017) in R/R aggressive NHL. J Clin Oncol 2018; 36(15_suppl): 7505 https://doi.org/10.1200/JCO.2018.36.15_suppl.7505
B Savoldo, CA Ramos, E Liu, MP Mims, MJ Keating, G Carrum, RT Kamble, CM Bollard, AP Gee, Z Mei, H Liu, B Grilley, CM Rooney, HE Heslop, MK Brenner, G Dotti. CD28 costimulation improves expansion and persistence of chimeric antigen receptor-modified T cells in lymphoma patients. J Clin Invest 2011; 121(5): 1822–1826 https://doi.org/10.1172/JCI46110
pmid: 21540550
17
SJ Schuster, J Svoboda, EA Chong, SD Nasta, AR Mato, Ö Anak, JL Brogdon, I Pruteanu-Malinici, V Bhoj, D Landsburg, M Wasik, BL Levine, SF Lacey, JJ Melenhorst, DL Porter, CH June. Chimeric antigen receptor T cells in refractory B-cell lymphomas. N Engl J Med 2017; 377(26): 2545–2554 https://doi.org/10.1056/NEJMoa1708566
pmid: 29226764
18
SS Neelapu, FL Locke, NL Bartlett, LJ Lekakis, DB Miklos, CA Jacobson, I Braunschweig, OO Oluwole, T Siddiqi, Y Lin, JM Timmerman, PJ Stiff, JW Friedberg, IW Flinn, A Goy, BT Hill, MR Smith, A Deol, U Farooq, P McSweeney, J Munoz, I Avivi, JE Castro, JR Westin, JC Chavez, A Ghobadi, KV Komanduri, R Levy, ED Jacobsen, TE Witzig, P Reagan, A Bot, J Rossi, L Navale, Y Jiang, J Aycock, M Elias, D Chang, J Wiezorek, WY Go. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med 2017; 377(26): 2531–2544 https://doi.org/10.1056/NEJMoa1707447
pmid: 29226797
19
DW Lee, JN Kochenderfer, M Stetler-Stevenson, YK Cui, C Delbrook, SA Feldman, TJ Fry, R Orentas, M Sabatino, NN Shah, SM Steinberg, D Stroncek, N Tschernia, C Yuan, H Zhang, L Zhang, SA Rosenberg, AS Wayne, CL Mackall. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial. Lancet 2015; 385(9967): 517–528 https://doi.org/10.1016/S0140-6736(14)61403-3
pmid: 25319501
20
FL Locke, SS Neelapu, NL Bartlett, T Siddiqi, JC Chavez, CM Hosing, A Ghobadi, LE Budde, A Bot, JM Rossi, Y Jiang, AX Xue, M Elias, J Aycock, J Wiezorek, WY Go. Phase 1 results of ZUMA-1: a multicenter study of KTE-C19 anti-CD19 CAR T cell therapy in refractory aggressive lymphoma. Mol Ther 2017; 25(1): 285–295 https://doi.org/10.1016/j.ymthe.2016.10.020
pmid: 28129122
21
DW Lee, R Gardner, DL Porter, CU Louis, N Ahmed, M Jensen, SA Grupp, CL Mackall. Current concepts in the diagnosis and management of cytokine release syndrome. Blood 2014; 124(2): 188–195 https://doi.org/10.1182/blood-2014-05-552729
pmid: 24876563
22
DW Lee, BD Santomasso, FL Locke, A Ghobadi, CJ Turtle, JN Brudno, MV Maus, JH Park, E Mead, S Pavletic, WY Go, L Eldjerou, RA Gardner, N Frey, KJ Curran, K Peggs, M Pasquini, JF DiPersio, MRM van den Brink, KV Komanduri, SA Grupp, SS Neelapu. ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biol Blood Marrow Transplant 2019; 25(4): 625–638 https://doi.org/10.1016/j.bbmt.2018.12.758
pmid: 30592986
23
SS Neelapu, S Tummala, P Kebriaei, W Wierda, C Gutierrez, FL Locke, KV Komanduri, Y Lin, N Jain, N Daver, J Westin, AM Gulbis, ME Loghin, JF de Groot, S Adkins, SE Davis, K Rezvani, P Hwu, EJ Shpall. Chimeric antigen receptor T-cell therapy—assessment and management of toxicities. Nat Rev Clin Oncol 2018; 15(1): 47–62 https://doi.org/10.1038/nrclinonc.2017.148
pmid: 28925994
24
KA Hay. Cytokine release syndrome and neurotoxicity after CD19 chimeric antigen receptor-modified (CAR-) T cell therapy. Br J Haematol 2018; 183(3): 364–374 https://doi.org/10.1111/bjh.15644
pmid: 30407609
25
Z Jin, R Xiang, K Qing, X Li, Y Zhang, L Wang, H Zhu, Y Mao, Z Xu, J Li. The severe cytokine release syndrome in phase I trials of CD19-CAR-T cell therapy: a systematic review. Ann Hematol 2018; 97(8): 1327–1335 https://doi.org/10.1007/s00277-018-3368-8
pmid: 29766234
26
KJ Curran, HJ Pegram, RJ Brentjens. Chimeric antigen receptors for T cell immunotherapy: current understanding and future directions. J Gene Med 2012; 14(6): 405–415 https://doi.org/10.1002/jgm.2604
pmid: 22262649
27
H Murthy, M Iqbal, JC Chavez, MA Kharfan-Dabaja. Cytokine release syndrome: current perspectives. ImmunoTargets Ther 2019; 8: 43–52 https://doi.org/10.2147/ITT.S202015
pmid: 31754614
28
SJ Schuster, MR Bishop, CS Tam, EK Waller, P Borchmann, JP McGuirk, U Jäger, S Jaglowski, C Andreadis, JR Westin, I Fleury, V Bachanova, SR Foley, PJ Ho, S Mielke, JM Magenau, H Holte, S Pantano, LB Pacaud, R Awasthi, J Chu, Ö Anak, G Salles, RT; JULIET Investigators Maziarz. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma. N Engl J Med 2019; 380(1): 45–56 https://doi.org/10.1056/NEJMoa1804980
pmid: 30501490