Tisagenlecleucel in Children and Young Adults with B-Cell Lymphoblastic Leukemia.
Submitted by Eneida R Nemecek on
Title | Tisagenlecleucel in Children and Young Adults with B-Cell Lymphoblastic Leukemia. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Maude, SL, Laetsch, TW, Buechner, J, Rives, S, Boyer, M, Bittencourt, H, Bader, P, Verneris, MR, Stefanski, HE, Myers, GD, Qayed, M, De Moerloose, B, Hiramatsu, H, Schlis, K, Davis, KL, Martin, PL, Nemecek, ER, Yanik, GA, Peters, C, Baruchel, A, Boissel, N, Mechinaud, F, Balduzzi, A, Krueger, J, June, CH, Levine, BL, Wood, P, Taran, T, Leung, M, Mueller, KT, Zhang, Y, Sen, K, Lebwohl, D, Pulsipher, MA, Grupp, SA |
Journal | N Engl J Med |
Volume | 378 |
Issue | 5 |
Pagination | 439-448 |
Date Published | 2018 02 01 |
ISSN | 1533-4406 |
Keywords | Adolescent, Antibodies, Monoclonal, Humanized, Antigens, CD19, Antineoplastic Combined Chemotherapy Protocols, Child, Child, Preschool, Female, Humans, Infusions, Intravenous, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Receptors, Antigen, T-Cell, Remission Induction, Survival Analysis, Young Adult |
Abstract | BACKGROUND: In a single-center phase 1-2a study, the anti-CD19 chimeric antigen receptor (CAR) T-cell therapy tisagenlecleucel produced high rates of complete remission and was associated with serious but mainly reversible toxic effects in children and young adults with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). METHODS: We conducted a phase 2, single-cohort, 25-center, global study of tisagenlecleucel in pediatric and young adult patients with CD19+ relapsed or refractory B-cell ALL. The primary end point was the overall remission rate (the rate of complete remission or complete remission with incomplete hematologic recovery) within 3 months. RESULTS: For this planned analysis, 75 patients received an infusion of tisagenlecleucel and could be evaluated for efficacy. The overall remission rate within 3 months was 81%, with all patients who had a response to treatment found to be negative for minimal residual disease, as assessed by means of flow cytometry. The rates of event-free survival and overall survival were 73% (95% confidence interval [CI], 60 to 82) and 90% (95% CI, 81 to 95), respectively, at 6 months and 50% (95% CI, 35 to 64) and 76% (95% CI, 63 to 86) at 12 months. The median duration of remission was not reached. Persistence of tisagenlecleucel in the blood was observed for as long as 20 months. Grade 3 or 4 adverse events that were suspected to be related to tisagenlecleucel occurred in 73% of patients. The cytokine release syndrome occurred in 77% of patients, 48% of whom received tocilizumab. Neurologic events occurred in 40% of patients and were managed with supportive care, and no cerebral edema was reported. CONCLUSIONS: In this global study of CAR T-cell therapy, a single infusion of tisagenlecleucel provided durable remission with long-term persistence in pediatric and young adult patients with relapsed or refractory B-cell ALL, with transient high-grade toxic effects. (Funded by Novartis Pharmaceuticals; ClinicalTrials.gov number, NCT02435849 .). |
DOI | 10.1056/NEJMoa1709866 |
Alternate Journal | N. Engl. J. Med. |
PubMed ID | 29385370 |
PubMed Central ID | PMC5996391 |
Grant List | KL2 TR002381 / TR / NCATS NIH HHS / United States UL1 TR002378 / TR / NCATS NIH HHS / United States |