Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
03 01 2019
03 01 2019
Historique:
pubmed:
7
12
2018
medline:
12
1
2019
entrez:
4
12
2018
Statut:
ppublish
Résumé
Patients with diffuse large B-cell lymphoma that is refractory to primary and second-line therapies or that has relapsed after stem-cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas in a single-center, phase 2a study. We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B-cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem-cell transplantation. The primary end point was the best overall response rate (i.e., the percentage of patients who had a complete or partial response), as judged by an independent review committee. A total of 93 patients received an infusion and were included in the evaluation of efficacy. The median time from infusion to data cutoff was 14 months (range, 0.1 to 26). The best overall response rate was 52% (95% confidence interval, 41 to 62); 40% of the patients had complete responses, and 12% had partial responses. Response rates were consistent across prognostic subgroups. At 12 months after the initial response, the rate of relapse-free survival was estimated to be 65% (79% among patients with a complete response). The most common grade 3 or 4 adverse events of special interest included cytokine release syndrome (22%), neurologic events (12%), cytopenias lasting more than 28 days (32%), infections (20%), and febrile neutropenia (14%). Three patients died from disease progression within 30 days after infusion. No deaths were attributed to tisagenlecleucel, cytokine release syndrome, or cerebral edema. No differences between response groups in tumor expression of CD19 or immune checkpoint-related proteins were found. In this international study of CAR T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma in adults, high rates of durable responses were produced with the use of tisagenlecleucel. (Funded by Novartis; JULIET ClinicalTrials.gov number, NCT02445248 .).
Sections du résumé
BACKGROUND
Patients with diffuse large B-cell lymphoma that is refractory to primary and second-line therapies or that has relapsed after stem-cell transplantation have a poor prognosis. The chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel targets and eliminates CD19-expressing B cells and showed efficacy against B-cell lymphomas in a single-center, phase 2a study.
METHODS
We conducted an international, phase 2, pivotal study of centrally manufactured tisagenlecleucel involving adult patients with relapsed or refractory diffuse large B-cell lymphoma who were ineligible for or had disease progression after autologous hematopoietic stem-cell transplantation. The primary end point was the best overall response rate (i.e., the percentage of patients who had a complete or partial response), as judged by an independent review committee.
RESULTS
A total of 93 patients received an infusion and were included in the evaluation of efficacy. The median time from infusion to data cutoff was 14 months (range, 0.1 to 26). The best overall response rate was 52% (95% confidence interval, 41 to 62); 40% of the patients had complete responses, and 12% had partial responses. Response rates were consistent across prognostic subgroups. At 12 months after the initial response, the rate of relapse-free survival was estimated to be 65% (79% among patients with a complete response). The most common grade 3 or 4 adverse events of special interest included cytokine release syndrome (22%), neurologic events (12%), cytopenias lasting more than 28 days (32%), infections (20%), and febrile neutropenia (14%). Three patients died from disease progression within 30 days after infusion. No deaths were attributed to tisagenlecleucel, cytokine release syndrome, or cerebral edema. No differences between response groups in tumor expression of CD19 or immune checkpoint-related proteins were found.
CONCLUSIONS
In this international study of CAR T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma in adults, high rates of durable responses were produced with the use of tisagenlecleucel. (Funded by Novartis; JULIET ClinicalTrials.gov number, NCT02445248 .).
Identifiants
pubmed: 30501490
doi: 10.1056/NEJMoa1804980
doi:
Substances chimiques
Receptors, Antigen, T-Cell
0
Receptors, Chimeric Antigen
0
tisagenlecleucel
Q6C9WHR03O
Banques de données
ClinicalTrials.gov
['NCT02445248']
Types de publication
Clinical Trial, Phase II
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
45-56Investigateurs
Paolo Corradini
(P)
Takanori Teshima
(T)
Koji Izutsu
(K)
Koji Kato
(K)
Craig Reeder
(C)
David Rizzieri
(D)
Koen Van Besien
(K)
Nina Wagner-Johnston
(N)
Marie José Kersten
(MJ)
Marliese Alexander
(M)
Michael J Dickinson
(MJ)
Simon Harrison
(S)
Dominic M Wall
(DM)
Christina Brown
(C)
Christian Bryant
(C)
Scott Dunkley
(S)
John Gibson
(J)
Harry Iland
(H)
Liane Khoo
(L)
Stephen Larsen
(S)
John Rasko
(J)
Claire Weatherburn
(C)
Marion Heinz
(M)
Bernadette Hilgarth
(B)
Georg Hopfinger
(G)
Mercedes Litzenberger
(M)
Martina Schlager
(M)
Ingrid Simonitsch-Klupp
(I)
Nina Worel
(N)
Amiee Hill
(A)
Olivier Hequet
(O)
Valérie Mialou
(V)
Hyatt Balke-Want
(H)
Boris Boel
(B)
Udo Holtick
(U)
Thorsten Bley
(T)
Markus Böck
(M)
Andreas Buck
(A)
Gérad Cabolet
(G)
Hermann Einsele
(H)
Matthias Eyrich
(M)
Gertrud Fragner
(G)
Mareike Frietsch
(M)
Nicole Furgol
(N)
Jürgen Geiger
(J)
Maria-Elisabeth Goebeler
(ME)
Goetz Grigoleit
(G)
Sigrid Harant
(S)
Anke Heidemeier
(A)
Matthias Hermann
(M)
Horst-Dieter Hummel
(HD)
Erdwine Kliniker
(E)
Volker Kunzmann
(V)
Constantin Lapa
(C)
Carmen Nordmo
(C)
Stefanie Obermeier
(S)
Christiane Oehrlein
(C)
Johannes Rachor
(J)
Andreas Rosenwald
(A)
Maximilian Steinhardt
(M)
Anette Thurner
(A)
Petra Thomas
(P)
Alicia Wittig
(A)
Cristiana Carniti
(C)
Paola Coluccia
(P)
Debora Degl'innocenti
(D)
Anna Dodero
(A)
Alberto Mussetti
(A)
Katsuya Fujimoto
(K)
Hideki Goto
(H)
Koji Hayasaka
(K)
Kaoru Kahata
(K)
Nozomi Sato
(N)
Junichi Sugita
(J)
Shunsuke Hatta
(S)
Katsuaki Imaizumi
(K)
Yuta Ito
(Y)
Shinichi Makita
(S)
Dai Maruyama
(D)
Tatsuya Suzuki
(T)
Yuko Tanoue
(Y)
Saki Yoshizawa
(S)
Koichi Akashi
(K)
Kaori Ebihara
(K)
Masako Fujise
(M)
Mitsuhiro Fukata
(M)
Masayasu Hayashi
(M)
Tomoko Henzan
(T)
Sho Iwasaka
(S)
Fumiaki Jinnouchi
(F)
Kenjiro Kamezaki
(K)
Yuya Kunisaki
(Y)
Takahiro Maeda
(T)
Mariko Minami
(M)
Toshihiro Miyamoto
(T)
Yasuo Mori
(Y)
Tomoko Nishida
(T)
Akihiko Numata
(A)
Takuya Nunomura
(T)
Toshihiko Okazaki
(T)
Hiromi Sakaguchi
(H)
Yuichiro Semba
(Y)
Takeshi Sugio
(T)
Katsuto Takenaka
(K)
Taro Tochigi
(T)
Yasufumi Uehara
(Y)
Takuji Yamauchi
(T)
Yui Yamauchi
(Y)
Goichi Yoshimoto
(G)
Ayano Yurino
(A)
B J Biemond
(BJ)
Patrick Burger
(P)
M J A G Claessen
(MJAG)
M D Hazenberg
(MD)
D M Heijink
(DM)
D Jhagroe
(D)
A P Kater
(AP)
Avigal Katevushnik-Brilleslijper
(A)
E M Kemper
(EM)
S Klein
(S)
R D K S Liu
(RDKS)
E Nur
(E)
M Rademaker
(M)
Anne Ruth Schaaphok
(AR)
L J Schouten
(LJ)
M Spiering
(M)
L Suijk
(L)
S H Tonino
(SH)
E van Dijkman
(E)
K Verdeyen
(K)
C Voermans
(C)
S S Zeerleder
(SS)
Marianne Brodtkorb
(M)
Jane Anderson
(J)
Nicole Aqui
(N)
Joan Gilmore
(J)
Lester Lledo
(L)
Karen Lowry
(K)
Leah Madden
(L)
Holly McConville
(H)
Ellen Napier
(E)
Mary Sell
(M)
Joanne Shea
(J)
Kim-Marie Shea
(KM)
Don Siegel
(D)
Jakub Svoboda
(J)
Peter Riedell
(P)
Brandon Hayes-Lattin
(B)
Clint Divine
(C)
Zahra Mahmoudjafari
(Z)
Crissy Morrison
(C)
Caroline Strohm
(C)
Erin Winters
(E)
Nicole Szuminski
(N)
Jonathon B Cohen
(JB)
Kunhee Lee Cox
(KL)
Amelia A Langston
(AA)
Steven Goldstein
(S)
Robertson Devenport
(R)
Maggi Kennel
(M)
Tycel Phillips
(T)
Anne Beaven
(A)
Ahmed Galal
(A)
Mathew Mckinney
(M)
Melissa Cushing
(M)
Usama Gergis
(U)
June Greenberg
(J)
Jing-Mei Hsu
(JM)
Yen Michael Hsu
(YM)
Maria Macapinlac
(M)
Peter Martin
(P)
Sebastian Mayer
(S)
Adrienne Phillips
(A)
Tsiporah Shore
(T)
Ronit Slotky
(R)
Ljiljana Vasovic
(L)
Richard Ambinder
(R)
Douglas Gladston
(D)
Cassandra Karcs
(C)
Louanne Morell
(L)
Kristen Murray
(K)
Amanda Stevens
(A)
Lode Swinnen
(L)
Noah Tucker
(N)
Lawrence Kaplan
(L)
Jeffrey Marsal
(J)
Jenai Wilmoth
(J)
Nathan Fowler
(N)
Souzanne Ouzounian
(S)
Francesco Turturro
(F)
Jill Adamski
(J)
Megan Altschuler
(M)
Jose Leis
(J)
Catherine Margosian
(C)
Commentaires et corrections
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