Autologous Anti-CD19 CAR T-Cells immunotherapy in relapsed/refractory acute lymphoblastic leukemia patients. A systematic review and meta-analysis
DOI:
https://doi.org/10.11606/issn.1679-9836.v101i5e-181721Palavras-chave:
Immunotherapy, Anti-CD19 CAR T-Cells, Acute Lymphoblastic Leukemia, Antígenos CD19Resumo
Introduction: Acute Lymphoblastic Leukemia (ALL) is the most prevalent malignancy in children; however, when the neoplasm becomes refractory/relapses (R/R) the cure possibilities are practically null. Objectives: To analyze the Anti-CD19 Chimeric Antigen Receptors (CAR) T-Cells immunotherapy efficacy in the treatment of R/R ALL, providing evidence about the efficacy and safety of the therapy for the analyzed group. Methods: The study consisted of a systematic review and meta-analysis based on the analysis of indexed articles. The searches were carried out with the terms: “acute lymphoblastic leukemia”, “CAR T”, and “CD19-specific chimeric antigen receptor”. Results: Only 18 of the 94 articles obtained initially met the inclusion criteria and were selected for review, totaling 637 patients. Thus, it was observed in the responses that approximately 81% of the patients achieved a Complete Response; 7% did not respond; the neoplasm relapsed in 17% of the cases; and 6.1% of the patients died. The main side effects found were Cytokine Release Syndrome (CRS), Severe Cytokine Release Syndrome, and Neurotoxicity, present in 36.3%, 29%, and 24% of patients, respectively. Conclusion: Anti-CD19 CAR T-Cells immunotherapy is an effective therapy, capable of producing high rates of complete remission in R/R ALL treatment.
Downloads
Referências
Kaatsch P. Epidemiology of childhood cancer. Cancer Treat Rev. 2010;36(4):277-85. doi: https://doi.org/10.1016/j.ctrv.2010.02.003
American Cancer Society. Typical Treatment of Acute Lymphocytic Leukemia (ALL). Atlanta, United States of America; 2021 [cited 2021 Oct 20]. Available from: https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating/typical-treatment.html
Liu D. CAR-T “the living drugs”, immune checkpoint inhibitors, and precision medicine: a new era of cancer therapy. J Hematol Oncol. 2019;12(1):113. doi: https://doi.org/10.1186/s13045-019-0819-1
Rosenbaum L. Tragedy, perseverance, and chance - the story of CAR-T therapy. N Engl J Med. 2017;377(14):1313-5. doi: https://doi.org/10.1056/NEJMp1711886
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: https://doi.org/10.1136/bmj.n71
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al.; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529-36. doi: https://doi.org/10.7326/0003-4819-155-8-201110180-00009
University of Bristol. Bristol Medical School: Population Health Sciences. QUADAS-2. Bristol, United Kingdom; 2011 [cited 2021 Jan 20]. Available from: https://www.bristol.ac.uk/media-library/sites/quadas/migrated/documents/quadas2.pdf
Park JH, Rivière I, Gonen M, Wang X, Sénéchal B, Curran KJ, et al. Long-Term Follow-up of CD19 CAR Therapy in Acute Lymphoblastic Leukemia. N Engl J Med. 2018;378(5):449-59. doi: https://doi.org/10.1056/NEJMoa1709919
Callahan C, Baniewicz D, Ely B. CAR T-cell therapy: pediatric patients with relapsed and refractory acute lymphoblastic leukemia. Clin J Oncol Nurs. 2017;21(2):22-8. doi: https://doi.org/10.1188/17.CJON.S2.22-28
Lee DW, Kochenderfer JN, Stetler-Stevenson M, Cui YK, Delbrook C, Feldman SA, et al. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial. Lancet. 2015;385(9967):517-28. doi: https://doi.org/10.1016/S0140-6736(14)61403-3
Gardner RA, Finney O, Annesley C, Brakke H, Summers C, Leger K, et al. Intent-to-treat leukemia remission by CD19 CAR T cells of defined formulation and dose in children and young adults. Blood. 2017;129(25):3322-31. doi: https://doi.org/10.1182/blood-2017-02-769208
Maude SL, Laetsch TW, Buechner J, Rives S, Boyer M, Bittencourt H, et al. Tisagenlecleucel in Children and Young Adults with B-Cell Lymphoblastic Leukemia. N Engl J Med. 2018;378(5):439-48. doi: https://doi.org/10.1056/NEJMoa1709866
Lee DW, Stetler-Stevenson M, Yuan CM, Fry TJ, Shah NN, Delbrook C, et al. Safety and response of incorporating CD19 chimeric antigen receptor T cell therapy in typical salvage regimens for children and young adults with acute lymphoblastic leukemia. Blood. 2015;126(23):684. doi: https://doi.org/10.1182/blood.V126.23.684.684
Gardner R, Wu D, Cherian S, Fang M, Hanafi LA, Finney O, et al. Acquisition of a CD19-negative myeloid phenotype allows immune escape of MLL-rearranged B-ALL from CD19 CAR-T-cell therapy. Blood. 2016;127(20):2406-10. doi: https://doi.org/10.1182/blood-2015-08-665547
Hu Y, Wang J, Wei G, Yu J, Luo Y, Shi J, et al. A retrospective comparison of allogenic and autologous chimeric antigen receptor T cell therapy targeting CD19 in patients with relapsed/refractory acute lymphoblastic leukemia. Bone Marrow Transplant. 2019;54(8):1208-17. doi: https://doi.org/10.1038/s41409-018-0403-2
Fitzgerald JC, Weiss SL, Maude SL, Barrett DM, Lacey SF, Melenhorst JJ, et al. Cytokine release syndrome after chimeric antigen receptor T cell therapy for acute lymphoblastic leukemia. Crit Care Med. 2017;45(2):124-31. doi: https://doi.org/10.1097/CCM.0000000000002053
Santomasso BD, Park JH, Salloum D, Riviere I, Flynn J, Mead E, et al. Clinical and biological correlates of neurotoxicity associated with CAR T-cell therapy in patients with B-cell acute lymphoblastic leukemia. Cancer Discov. 2018;8(8):958-971. doi: https://doi.org/10.1158/2159-8290.CD-17-1319
Hay AE, Cheung MC. CAR T-cells: costs, comparisons, and commentary. J Med Econ. 2019;22(7):613-615. doi: https://doi.org/10.1080/13696998.2019.1582059
Lebien TW, Tedder TF. B lymphocytes: how they develop and function. Blood. 2008;112(5):1570–80. doi: https://doi.org/10.1182/blood-2008-02-078071
Grupp SA, Laetsch TW, Buechner J, Bittencourt H, Maude SL, Verneris MR, et al. Analysis of a Global Registration Trial of the Efficacy and Safety of CTL019 in Pediatric and Young Adults with Relapsed/Refractory Acute Lymphoblastic Leukemia (ALL). Blood 2016;128(22):221. doi: https://doi.org/10.1182/blood.V128.22.221.221
Dai H, Zhang W, Li X, Han Q, Guo Y, Zhang Y, et al. Tolerance and efficacy of autologous or donor-derived T cells expressing CD19 chimeric antigen receptors in adult B-ALL with extramedullary leukemia. Oncoimmunology. 2015;4(11):e1027469. doi: https://doi.org/10.1080/2162402X.2015.1027469
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2022 Ricardo Pasquini Neto, Felipe Antonio Torres Mazzo, Gustavo de Souza Bueno, João Vitor Correa Previdi, Nasthia Kreuz Baziulis da Silva, Tulio da Silva Vieira, Maria Cristina Figueroa Magalhães
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.