Type: Oral
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: B Cell-directed CAR T Cell Therapies for ALL and for Autoimmunity
Hematology Disease Topics & Pathways:
Research, Clinical trials, Autoimmune hemolytic anemia, Clinical Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Immune Disorders, Treatment Considerations, Biological therapies, Immunology, Infusion, Human
Refractory AIHA patients who had failed at least three lines of therapies were enrolled in a compassionate-use CD19 CAR T-cell program (n = 5) and phase I clinical trial (NCT06231368) (n = 3) to evaluate the safety and efficacy. Patients received a single dose infusion of autologous CD19 CAR T-cell 1×106 cells/kg (compassionate use) and 0.5×106 cells/kg (phase I clinical trial, dose 1) respectively after preconditioning with fludarabine (25 mg/m²/day on days -5 to -3) and cyclophosphamide (1.0 g/m²/day on day -3). Safety assessments included cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), hematologic and non-hematologic toxicities were assessed according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Efficacy was evaluated based on hemoglobin levels and biochemical markers of hemolysis. Single-cell RNA sequencing (scRNA-seq) and single-cell V(D)J sequencing were performed to monitor the process of B cell reconstitution in bone marrow (BM) and peripheral blood (PB) at baseline, 12 weeks (W12), and month 6 (M6) after CD19 CAR T-cell infusion.
As of July 31, 2024, the median follow-up time for the 8 patients were 6.8 months (range, 0.8-10.5 months). The safety profile in these 8 patients was satisfactory: 5 patients experienced grade 1 CRS, and two patients experienced grade 2 CRS. One patient each had grade 1 CRS and grade 1 ICANS. No hospitalization due to severe infections occurred during the follow-up period. Among the 7 patients currently evaluable for efficacy, all achieved complete remission (CR), yielding a CR rate of 100%. One relapse was observed in compassionate-use UPN2 of at 6.8 months, maintaining DFR for 6.3 months. The median duration of sustained DFR was 6.3 months (range, 1.3-9.7 months). The median time to partial remission (PR) was 15 days (range, 11-27 days) and to CR was 57 days (range, 26-118 days). CAR T-cell levels rapidly expanded after infusion, reaching peak concentrations at a median time of 10 days (range, 7-11 days). At the peak of expansion, the median number of circulating CAR T-cell was 118.8 cells/ul (range, 44.9 to 244.6 cells/ul). B-cell aplasia lasted a median of 85 days (range, 57-91 days) in 6 patients who have undergone immune B cells reconstitution. scRNA-seq and single-cell V(D)J sequencing data showed that B-cell lineage and plasmablasts were reset in both BM and PB.
CD19 CAR T-cell therapy induce rapid remission, unprecedented DFR, and favorable safety profile in rAIHA patients. These exciting data support CAR T-cell as a novel strategy for autoimmune hemolytic anemia, and provide rationale for further clinical trials.
Disclosures: No relevant conflicts of interest to declare.