Jurnal Internasional Sel T CD19 CAR setelah transplantasi autologous pada limfoma non-Hodgkin non-Hodgkin sel B yang beresiko rendah dan kambuh

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Jurnal Internasional Sel T CD19 CAR setelah transplantasi autologous pada limfoma non-Hodgkin non-Hodgkin sel B yang beresiko rendah dan kambuh

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High-dose chemotherapy and autologous stem cell transplantation (HDT-ASCT) are the standard of care for relapsing or diffuse primary (rel / ref) chemorefractory primary lymphoma B cells. Only 50% of patients recover with this approach. We investigated the safety and efficacy of CD19 specific chimeric antigen receptor (CAR) T cells given after HDT-ASCT. Eligibility for this study included relosive aggressive B / lymphoma non-Hodgkin cells at low risk of being at risk for rescue therapy by: (1) positron emission-positive tomography or (2) bone marrow involvement. The patient underwent the HDT-ASCT standard followed by 19-28z CAR T cells on +2 and +3 days. Of the 15 subjects treated in the study, dose-limiting toxicity was observed at both dose levels (5 x 10 6 and 1 x 10 7 7 ] 19-28z CAR T per kilogram). Ten of the 15 subjects experienced neurotoxicity triggered by CAR T cells and / or cytokine release syndromes (CRS), which were associated with greater CAR T cell persistence ( P = 0.05) but did not peak CAR T – cell expansion. Increased serum ( P <.001 dan="" mungkin="" interleukin-10=""> P = .07) is associated with toxicity. 2-year development-free survival (PFS) is 30% (95% confidence interval, 20% to 70%). Subjects were dropped such as naively (CD45RA + CCR7 + ) CD4 + and CD8 + CAR T cells experienced superior PFS ( ]] P = 0.02 and 0.04, respectively). There is no relationship between CAR T cell peak expansion, persistence, or cytokine changes and PFS. CAR T cells 19-28z after HDT-ASCT are associated with a high incidence of neurotoxicity and CRS. Following HDT-ASCT, CD4 effectors + and CD8 + immunophenotypes can improve disease control. This trial is listed in www.clinicaltrials.gov as # NCT01840566.

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