重庆市首例CAR-T细胞治疗难治性急性B淋巴细胞白血病并文献复习

发布时间：2018-11-13 17:48

【摘要】：目的观察重庆市首例嵌合抗原受体T细胞(CAR-T)治疗复发难治性急性B淋巴细胞白血病的效果并文献复习。方法 60岁女性患者,2014年9月以"活动后乏力、皮肤紫癜"起病,2014年11月在该院确诊为急性B淋巴细胞白血病,多次联合化疗未达完全缓解,骨髓原幼淋巴细胞在75%~88%。2015年4月2日行外周血淋巴细胞单采、培养,2015年4月11日,予氟达拉滨40mg(第1~3天)+环磷酰胺300mg(第1~2天)、400mg(第3天)方案预处理。2015年4月16日输注培养后的嵌合CD19抗原受体T细胞1×106/kg。结果输注30d后骨髓细胞学为完全缓解,微小残留病阴性。第60天骨髓检查发现白血病复发;流式免疫分型提示白血病细胞不表达CD19。输注嵌合CD19抗原受体T细胞第6天患者出现发热、血压下降等炎性因子释放综合征表现,经对症处理后好转。结论 CAR-T细胞治疗技术是治疗难治复发CD19抗原阳性急性淋巴细胞白血病的有效方法,能够降低耐药患者体内肿瘤负荷,甚至达到完全缓解,但白血病复发的问题任然存在,部分复发病例出现CD19抗原缺失。
[Abstract]:Objective to observe the efficacy of chimeric antigen receptor T cell (CAR-T) in the treatment of relapsing refractory acute B lymphocytic leukemia (ARL) in Chongqing. Methods A 60-year-old female patient was diagnosed with acute B lymphoblastic leukemia (ACL) in November 2014 with "post-active fatigue, skin purpura", and was not completely relieved by multiple combined chemotherapy. Peripheral blood lymphocytes were collected and cultured on April 2, 2015. On April 11, 2015, fludarabine 40mg (day 1, day 3) and cyclophosphamide 300mg (day 1, day 2) were given. 400mg (3rd day) preconditioning. The chimeric CD19 receptor T cells were infused on April 16, 2015. Results after 30 days of infusion, bone marrow cytology was completely relieved and minimal residual disease was negative. On the 60th day, leukemia recurrence was found by bone marrow examination, and flow cytometry showed that leukemic cells did not express CD19.. On the 6th day, fever, blood pressure drop and other inflammatory factor releasing syndrome were observed in patients with chimeric CD19 antigen receptor T cells, and were improved after symptomatic treatment. Conclusion CAR-T cell therapy is an effective method for the treatment of refractory relapsed CD19 antigen-positive acute lymphoblastic leukemia. It can reduce tumor load and even achieve complete remission in drug-resistant patients. However, the recurrence of leukemia still exists. CD19 antigen deletion was found in some recurrent cases.
【作者单位】：第三军医大学新桥医院全军血液病中心;
【分类号】：R733.71

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