CD22CAR-T挽救治疗CD19CAR-T治疗后短期复发的TP53突变阳性难治急性B淋巴细胞白血病一例  

CD22 CAR-T salvage therapy for a refractory acute B lymphocytic leukemia patient with TP53positive mutation and short-term recurrence after remission from CD19 CAR-T therapy

作　　者：穆娟[1] 吕海容[1] 李静怡[1] 江嫣雨 张蕊[1] 孟娟霞[1] 袁婷 邓琦[1] MU Juan;LYU Hai-rong;LI Jing-yi;JIANG Yan-yu;ZHANG Rui;MENG Juan-xia;YUAN Ting;DENG Qi(Department of Hematology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院血液科,300192

出　　处：《天津医药》2020年第4期308-312,共5页Tianjin Medical Journal

摘　　要：难治急性淋巴细胞白血病病死率极高,CAR-T细胞免疫治疗为此提供新的选择。本文介绍1例CD19 CAR-T细胞治疗缓解后短期复发的TP53突变阳性难治急性B淋巴细胞白血病,经CD22CAR-T联合单倍体异基因造血干细胞移植治疗成功的病例。本研究采用流式细胞术观察患者CD19CAR-T细胞和CD22CAR-T细胞两次治疗的外周血CAR-T细胞比例,PCR法检测CAR基因表达;临床观察患者2次CAR-T细胞治疗过程中的疗效和不良反应。结果显示,CD19CAR-T和CD22CAR-T细胞2次治疗均于第14天达到骨髓完全缓解,且不良反应轻微。但CD19CAR-T细胞治疗缓解后2周骨髓复发,患者外周血检测到异常19CAR基因表达,同时TP53突变水平亦增高。最终CD22CAR-T细胞挽救治疗桥接单倍体造血干细胞移植后成功。由此表明在细胞制备过程中应进一步提高CD3+细胞纯度;CD22CAR-T治疗可以作为CD19CAR-T治疗复发的一个挽救治疗措施。The mortality rate of the acute lymphocyte disease is extremely high,and CAR-T cell immunotherapy provides a new choice.This paper introduced a refractory acute B-lymphoblastic leukemia(B-ALL)patient with TP53 positive mutation and short-term recurrence after remission from CD19 CAR-T therapy.The case was successfully treated by CD22 CAR-T combined with allogeneic hematopoietic stem cell transplantation.The proportions of peripheral blood CD19 CAR-T and CD22 CAR-T cells were analyzed by flow cytometry.The expression of CAR gene in peripheral blood was detected by PCR method.The efficacy and the side effects of CD19 CAR-T and CD22 CAR-T therapy were observed in this patient.The CD19 CAR-T and CD22 CAR-T cell treatments both achieved complete remission on the day 14,and the side effects were minor.But bone marrow recurrence 2 weeks after remission from CD19 CAR-T cell therapy with abnormal 19 CAR gene expression in peripheral blood and increased TP53 mutation level.The patient was successfully treated with CD22 CAR-T cells bridged with haploid hematopoietic stem cell transplantation therapy.In a word,the purity of CD3+cells should be further improved in the process of CAR-T cell manufacture.CD22 CAR-T therapy could be used as a salvage measures for the patient with relapse of CD19 CAR-T therapy.

关 键 词：急性淋巴细胞白血病 CD19 CAR-T CD22 CAR-T TP53基因突变 造血干细胞移植 

分 类 号：R733.71[医药卫生—肿瘤]