Chimeric antigen receptor T (CAR-T) cell therapy is highly effective in inducing complete remission in haematological malignancies. Severe cytokine release syndrome (CRS) is the most significant and life-threatening adverse effect of this therapy. This multi-centre study was conducted at six hospitals in China. The training cohort included 87 patients with multiple myeloma (MM), an external validation cohort of 59 patients with MM and another external validation cohort of 68 patients with acute lymphoblastic leukaemia (ALL) or non-Hodgkin lymphoma (NHL). The levels of 45 cytokines on days 1-2 after CAR-T cell infusion and clinical characteristics of patients were used to develop the nomogram. A nomogram was developed, including CX3CL1, GZMB, IL4, IL6 and PDGFAA. Based on the training cohort, the nomogram had a bias-corrected AUC of 0.876 (95% CI = 0.871-0.882) for predicting severe CRS. The AUC was stable in both external validation cohorts (MM, AUC = 0.907, 95% CI = 0.899-0.916; ALL/NHL, AUC = 0.908, 95% CI = 0.903-0.913). The calibration plots (apparent and bias-corrected) overlapped with the ideal line in all cohorts. We developed a nomogram that can predict which patients are likely to develop severe CRS before they become critically ill, improving our understanding of CRS biology, and may guide future cytokine-directed therapies.

Follicular lymphoma (FL) is generally considered an indolent disease, although patients with relapsing FL experience progressively shorter durations of response to second or later lines of therapy. The ongoing ELARA trial in adult patients with relapsed/refractory (r/r) FL treated with tisagenlecleucel demonstrated an overall response rate of 86.2% and a complete response rate of 69.1%, with no treatment-related deaths. Tisagenlecleucel was administered in the outpatient setting in 18% of patients in ELARA; however, there is limited knowledge concerning the impact of inpatient versus outpatient tisagenlecleucel administration on healthcare resource utilization (HCRU) among patients with r/r FL. Here, we present the first HCRU analysis among patients with r/r FL who received tisagenlecleucel in the Phase II, single-arm, multicenter ELARA trial. HCRU was characterized using hospitalization data from day 1 to month 2 after tisagenlecleucel infusion. Information on length of stay, facility use, and discharge was assessed in patients who received tisagenlecleucel in the outpatient or inpatient setting. All costs were inflated to 2020 US dollars. As of August 3, 2021 (20-month median follow-up), 17/97 (18%) r/r FL patients were infused in an outpatient setting. Patients infused in the outpatient setting generally had favorable Eastern Cooperative Oncology Group performance status and Follicular Lymphoma International Prognostic Index scores, and less bulky disease at baseline. However, the outpatients had higher proportions of patients with grade 3A FL, primary refractory disease, and >5 lines of prior therapy compared with inpatients. Forty-one percent of patients treated in the outpatient setting did not require hospitalization within 30 days after infusion, and outpatients who did require hospitalization had a shorter average length of stay compared with inpatients (5 versus 13 days). No outpatients required intensive care unit (ICU) admission, whereas 9% of inpatients were admitted to the ICU. The mean postinfusion hospitalization costs were $7477 and $40,054 in the outpatient and inpatient settings, respectively. Efficacy between both groups was similar. Tisagenlecleucel can be safely administered to some patients in the outpatient setting, which may reduce HCRU for patients with r/r FL.

BACKGROUND: Cilta-cel, a CAR-T cell therapy with 2 BCMA-targeting single-domain antibodies, led to early, deep, and durable responses in heavily pretreated patients with RRMM in the phase 1b/2 CARTITUDE-1 study (NCT03548207).
OBJECTIVE: To report updated results from CARTITUDE-1. Data 2-years post LPI (~30-month median follow-up [MFU]) will be presented; here we report results at 21.7-month MFU.
METHODS: Eligible patients with RRMM had ≥3 prior lines of therapy (LOT) or were refractory to a proteasome inhibitor (PI) and immunomodulatory drug (IMiD) and had received a PI, IMiD, and anti-CD38 antibody.
METHODS: After apheresis, bridging therapy was allowed. A single infusion of cilta-cel (target dose 0.75×106 CAR+ viable T cells/kg) was administered 5-7 days after lymphodepletion.
METHODS: Cilta-cel safety and efficacy were the primary objectives. Assessments included response (per IMWG criteria by independent review committee) and minimal residual disease (MRD) negativity (at 10-5 by next-generation sequencing).
RESULTS: As of July 22, 2021, 97 patients (59% male; median age 61 years; median 6 [range 3-18] prior LOT) received cilta-cel. Overall response rate was 97.9% (94.9% very good partial response; 82.5% stringent complete response). Median times to first response, best response, and ≥complete response were 1.0, 2.6, and 2.9 months, respectively. Median duration of response was not reached. Among 61 MRD-evaluable patients, 92% were MRD negative (10-5), sustained for ≥6 months in 44% and ≥12 months in 18%. Progression-free survival (PFS) at 2 years was 60.5%. Median PFS and overall survival were not reached. PFS rates at 2 years in patients with MRD negativity sustained for ≥6 months and ≥12 months were 91% and 100%, respectively. No new safety signals, new events of CAR-T cell neurotoxicity, movement and neurocognitive treatment-emergent adverse events, or treatment-related deaths have occurred since 1-year MFU. Over ~2 years MFU, 15 second, primary malignancies were reported in 11 patients.
CONCLUSIONS: At ~2 years MFU, a single infusion of cilta-cel resulted in deepening and durable responses and manageable safety in heavily pretreated patients with RRMM. Additional research is ongoing to evaluate cilta-cel in earlier LOT and outpatient settings across the CARTITUDE program (NCT04133636, NCT04181827, NCT04923893).

BACKGROUND: CARTITUDE-2 (NCT04133636) Cohort B is evaluating cilta-cel in patients with MM and early relapse after initial therapy. These patients have functionally high-risk disease and unmet medical needs, as early relapse post-ASCT is associated with a poor prognosis.
OBJECTIVE: To present updated results from CARTITUDE-2 Cohort B.
METHODS: Phase 2, multicohort study.
METHODS: Eligible patients had MM, 1 prior LOT (PI and IMiD required), disease progression per IMWG, and no previous treatment with CAR-T/anti-BCMA therapies.
METHODS: Single cilta-cel infusion (target dose 0.75×106 CAR+ viable T-cells/kg) post lymphodepletion.
METHODS: Safety and efficacy were evaluated. Primary endpoint was MRD negativity at 10-5. Management strategies were used to reduce the risk of movement/neurocognitive AEs (MNTs). Assessments included pharmacokinetics (PK) (Cmax, Tmax of CAR+ T-cell transgene levels in blood), CRS-related cytokine (eg, IL-6) levels over time, peak cytokine levels by response and CRS, association of cytokine levels with ICANS, and CAR+ T-cell CD4/CD8 ratio by response, CRS, and ICANS.
RESULTS: As of January 2022 (median follow-up 13.4 months), 19 patients (median age 58.0 years; 74% male; 79% with prior ASCT) received cilta-cel. ORR was 100% (90% ≥CR and 95% ≥VGPR). Median time to first response was 0.95 months and median time to best response was 5.1 months. Median DOR was not reached. Of 15 MRD-evaluable patients, 14 (93%) achieved MRD 10-5 negativity. At 12 months, the event-free rate was 88.9% and PFS rate was 90%. CRS occurred in 16 (84.2%) patients (1 gr 4); median time to onset was 8 days. CRS resolved in all patients. 1 patient had ICANS (gr 1); 1 patient had MNT (gr 3; previously reported). 1 death occurred post-cilta-cel due to progressive disease (day 158). Preliminary PK data showed CAR-T cell peak expansion on day 13.1 and median persistence was 76.9 days.
CONCLUSIONS: A single cilta-cel infusion resulted in deep and durable responses and manageable safety in functionally high-risk patients with MM and early clinical relapse/treatment failure to initial therapy. We will present updated and detailed PK/cytokine/CAR-T subset analyses and clinical correlations to provide novel insights into biological correlates of efficacy/safety in this population.

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.

UNASSIGNED: Chimeric antigen receptor T (CAR-T) cells are effective in treating hematological malignancies. However, in patients receiving CAR-T therapy, data characterizing cardiac disorders are limited.
UNASSIGNED: 126 patients with hematologic malignancies receiving CAR-T cell therapy were analyzed to determine the impact of CAR-T therapy on occurrence of cardiac disorders, including heart failure, arrhythmias, myocardial infarction, which were defined by the Common Terminology Criteria for Adverse Events (CTCAE). Parameters related to cardiac disorders were detected including myocardial enzyme, NT-proBNP and ejection fraction (EF). Cardiovascular (CV) events included decompensated heart failure (HF), clinically significant arrhythmias and CV death.
UNASSIGNED: The median age of patients was 56 years (6 to 72 years). 58% patients were male, 62% had multiple myeloma, 20% had lymphoma and 18% had ALL. 33 (26%) patients had cardiac disorders, most of which were grade 1-2. 13 patients (10%) were observed with cardiac disorders grade 3-5, which comprised 5(4%) patients with new-onset HF, 2 (2%) patients with new-onset arrhythmias, 4 (3%) patients with the acute coronary syndrome, 1(1%) patient with myocardial infarction and 1(1%) patient with left ventricular systolic dysfunction. There were 9 CV events (7%) including 6 decompensated heart failure, 1 clinically significant arrhythmias and 2 CV deaths. Among the 33 patients with cardiac disorders, the patients with cardiac disorders CTCAE grade 3-5 had higher grade CRS (grade ≥ 3) than those with cardiac disorders CTCAE grade ≤ 2 (P <0.001). More patients with cardiac disorders CTCAE grade 3-5 were observed in the cohort who did not receive corticosteroids and/or tocilizumab therapy timely comparing with those who received corticosteroids and/or tocilizumab therapy timely (P =0.0004).
UNASSIGNED: Cardiac disorders CAR-T cell therapy were common and associated with occurrence of CRS. However, most cases were mild. For patients with CRS grade 3-5, timely administration of corticosteroids and/or tocilizumab can effectively prevent the occurrence and progression of cardiac disorders.

UNASSIGNED: The correlation between the radiosensitivity genes combined with CD19 status and clinical outcome was investigated to identify gastric cancer (GC) patients who would benefit from radiotherapy combined with CAR-T cell therapy.
UNASSIGNED: The gene expression and clinical features were downloaded from The Cancer Genome Atlas (TCGA) Stomach Cancer (STAD). To identify the hub radiosensitivity genes and CD19 status, 407 patients were categorized into two groups: radiosensitivity (RS) and radioresistance (RR) based on the prognosis. The chi-square test, Mann-Whitney test, and Kaplan-Meier survival analysis were applied to compare the differential expression in these groups and analyze the correlation between the gene expression and clinical outcome and features. Finally, the influencing factors for the prognosis of GC were investigated by multiple Cox regression, especially in RS patients.
UNASSIGNED: A total of 15 differential expression genes, containing two communities with 8 hub radiosensitivity genes, were identified. We also identified a 2-gene signature model with a negative coefficient and calculated the risk score for the prognosis of GC. Also, Helicobacter pylori infection was validated, and the high-risk score of radiosensitivity genes was the risk factor, and high CD19 expression was the protective factor for the prognosis.
UNASSIGNED: The radiosensitivity gene signature and CD19 expression predicted the clinical outcome of GC patients.

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