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2017 ; 129
(25
): 3322-3331
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Intent-to-treat leukemia remission by CD19 CAR T cells of defined formulation and
dose in children and young adults
#MMPMID28408462
Gardner RA
; Finney O
; Annesley C
; Brakke H
; Summers C
; Leger K
; Bleakley M
; Brown C
; Mgebroff S
; Kelly-Spratt KS
; Hoglund V
; Lindgren C
; Oron AP
; Li D
; Riddell SR
; Park JR
; Jensen MC
Blood
2017[Jun]; 129
(25
): 3322-3331
PMID28408462
show ga
Transitioning CD19-directed chimeric antigen receptor (CAR) T cells from
early-phase trials in relapsed patients to a viable therapeutic approach with
predictable efficacy and low toxicity for broad application among patients with
high unmet need is currently complicated by product heterogeneity resulting from
transduction of undefined T-cell mixtures, variability of transgene expression,
and terminal differentiation of cells at the end of culture. A phase 1 trial of
45 children and young adults with relapsed or refractory B-lineage acute
lymphoblastic leukemia was conducted using a CD19 CAR product of defined CD4/CD8
composition, uniform CAR expression, and limited effector differentiation.
Products meeting all defined specifications occurred in 93% of enrolled patients.
The maximum tolerated dose was 10(6) CAR T cells per kg, and there were no deaths
or instances of cerebral edema attributable to product toxicity. The overall
intent-to-treat minimal residual disease-negative (MRD(-)) remission rate for
this phase 1 study was 89%. The MRD(-) remission rate was 93% in patients who
received a CAR T-cell product and 100% in the subset of patients who received
fludarabine and cyclophosphamide lymphodepletion. Twenty-three percent of
patients developed reversible severe cytokine release syndrome and/or reversible
severe neurotoxicity. These data demonstrate that manufacturing a
defined-composition CD19 CAR T cell identifies an optimal cell dose with highly
potent antitumor activity and a tolerable adverse effect profile in a cohort of
patients with an otherwise poor prognosis. This trial was registered at
www.clinicaltrials.gov as #NCT02028455.