Recently, Beijing Katie Medical Technology Co., Ltd. cooperated with the Department of Hematology of Beijing Children's Hospital to conduct a semi-consensus CD19 CAR-T cell therapy for a patient with acute B lymphocytic leukemia who had relapsed after allogeneic hematopoietic stem cell transplantation (alloHSCT). I am happy.
The patient was a 9-year-old girl. She was diagnosed with acute B-lymphocytic leukemia in September 2015. She was given allogeneic hematopoietic stem cell transplantation (allo-HSCT), but soon after relapse of myeloid minimal residual disease (MRD), she relapsed. The patient was also given donor lymphocyte infusion (DLI) and still failed to effectively control leukemia. At this time, if DLI is continued, there is little possibility of clearing the MRD, and there is a risk of inducing severe graft-versus-host disease (GVHD). If chemotherapy is performed, the implanted donor cells are killed and the graft-resistant leukemia (GVL) effect is attenuated.
After consulting the CAR-T treatment technology of Beijing Katie Medical, the director of the bone marrow transplant ward of the Beijing Children's Hospital Blood Cancer Center decided to boldly adopt a groundbreaking treatment plan, without any chemotherapy pretreatment. The patient was directly infused with CD19 CAR-T cells prepared from haploid (semi-conform) peripheral blood T cells from his mother.
On October 24, 2016, patients were given CAR-T cells. After that, the patient developed a grade 1 cytokine release syndrome (CRS) such as fever and rash, which was relieved after drug treatment. More than 20 days after infusion of CAR-T cells, a surprising event occurred, and the patient's minimal residual leukemia (MRD) test turned negative. CAR-T cells clear tumor cells in such a short period of time, showing a very magical effect. At present, the patient has been treated with allogeneic CD19 CAR-T for more than 3 months, and the bone marrow MRD is still negative, and the overall condition is good.
Allogeneic hematopoietic stem cell transplantation can cure some B-lineage malignancies, but some patients still relapse after alloHSCT. The success of this case undoubtedly opened up a avenue of hope for patients with B-line tumors who have relapsed.
There are two points worthy of attention in this case. First, this time the use of haploidentical cell therapy. The traditional CAR-T protocol uses autologous rather than allogeneic cells. The benefits of autologous cells are obviously to avoid GVHD, but for patients who have experienced disease and multiple chemotherapy, their immune cells tend to be less active than ordinary people, and the efficacy of CAR-T will be greatly reduced. The success of this CAR-T is not unrelated to the choice of the variant. (In December 2016, Peking University People's Hospital also reported a case of semi-consistent CAR-T, which is very close to the treatment time of this case)
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