In the dynamic field of hematology and oncology, the development of innovative treatments for challenging conditions such as relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL) remains a critical priority. In this commentary, the recent phase 2 clinical trial investigating the efficacy of sequential CD19 and CD22 CAR T-cell therapies represents a significant advancement in the therapeutic landscape. Professor Kailin Xu from the Affiliated Hospital of Xuzhou Medical University, along with esteemed colleagues, offers new hope for patients facing this aggressive malignancy. He highlighted the findings of this pioneering research, published in the Lancet Oncology, which reported not only the potential of sequential CD19 and CD22 CAR T-cell therapy as a viable treatment option, but also the collaborative effort and expertise that exemplify the spirit of innovation in the field.This study aimed to evaluate the effectiveness and safety of sequential infusion of CD19 and CD22 chimeric antigen receptor (CAR) T-cell therapies in pediatric patients with relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL). The goal was to reduce relapse rates and improve long-term remission compared to single-agent CAR T-cell therapy.
In the study, a Phase 2 clinical trial was conducted, registered as NCT04340154, to evaluate the efficacy and safety of a specific treatment approach. The trial involved 81 pediatric patients, ranging in age from 1 to 18 years. The intervention consisted of a sequential infusion of CD19 and CD22 chimeric antigen receptor (CAR) T-cells, with a median interval of 39 days between the two infusions. Eligibility for this treatment was based on the patients having achieved a minimal residual disease (MRD)-negative status following the infusion of CD19 CAR T-cells, indicating that the initial treatment had effectively eliminated detectable cancer cells and the patients were in remission.
The sequential infusion strategy demonstrated high remission rates and significant durability, with a notably low rate of antigen-negative relapse. The results suggest that this approach can reduce tumor immune escape, a common challenge in single-agent CD19 CAR T-cell therapies.
This study highlights the potential of sequential CAR T-cell therapy as a viable alternative to allogeneic hematopoietic stem cell transplantation (allo-HSCT) for maintaining remission in pediatric patients with r/r B-ALL. The lower relapse rates and manageable adverse events make this approach promising for further development and application.
Click to read the original article: https://journals.lww.com/bls/fulltext/2024/01000/sequential_infusion_of_two_different_chimeric.1.aspx
