Relapsed/refractory B-cell malignancies: CAR-T “cocktail” offers promise against antigen escape relapse

  • Wang N, et al.
  • Blood
  • 29 Oct 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with relapsed/refractory (R/R) B-cell malignancies, sequential CD19- and CD22-directed chimeric antigen receptor-engineered T cells (CAR19/22) was safe and effective, and associated with a low rate of antigen escape relapse.

Why this matters

  • Malignant B cells have developed multiple antigen escape mechanisms driving CD19-negative relapse following CD19-directed therapy.

Study design

  • Study to investigate infusion of 2 sequential CAR-T cell therapies in 89 patients with R/R B-cell malignancies.
  • Funding: National Natural Science Foundation of China; Natural Science Foundation of Hubei Province; Huanghe Talents Plan of Wuhan City; National High Technology Research and Development Program of China; Milstein Medical Asian American Partnership Foundation; Applied Basic Research Project of Wuhan City.

Key results

  • In acute lymphoblastic leukemia (n=51):
    • 96.0% (95% CI, 86.3%-99.5%) achieved minimal residual disease negativity (MRD−).
  • At 16.7 (range, 1.3-33.3) months median follow-up:
    • 31.0 months (95% CI, 10.6 to NR) median OS.
  • In non-Hodgkin lymphoma (n=38):
    • 72.2% (95% CI, 54.8%-85.8%) overall response; 50.0% (95% CI, 32.9%-67.1%) complete response.
  • At 14.4 (range, 0.4-27.4) months median follow-up:
    • 18.0 months (95% CI, 6.1 to NR) median OS.
  • 1 patient experienced antigen loss relapse.

Limitations

  • Limited sample size.