Chidamide and sintilimab combination in diffuse large B-cell lymphoma progressing after chimeric antigen receptor T therapy.
Chidamide and sintilimab combination in diffuse large B-cell lymphoma progressing after chimeric antigen receptor T therapy.
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DOI：
10.12998/wjcc.v10.i19.6555
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发表时间：
2022-07-06
影响因子：
1.1
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中科院分区：
文献类型：
--
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弥漫性大b细胞淋巴瘤（DLBCL）可以通过一线化学免疫治疗治愈，但复发/难治性（R/R） DLBCL患者仍然面临不良预后。对于R/R DLBCL患者，传统一线治疗的完全缓解率仅为7%，中位总生存期为6.3个月。最近，靶向cd19的嵌合抗原受体T细胞（CAR-T）在临床试验中显示出希望。然而，大约50%接受CAR-T细胞治疗的患者最终病情恶化，而且很少有挽救性疗法是有效的。在这里，我们报告了7例CAR-T输注后病情进展的R/R DLBCL患者。他们接受了PD-1抑制剂（sintilimab）和组蛋白去乙酰化酶抑制剂（chidamide）。7例患者中有5例耐受治疗，未发生严重不良事件。2例患者因肺部感染和皮疹停止治疗。在20个月的随访中，这7名患者的中位总生存期为6个月。值得注意的是，在这种新疗法中，有2个完全缓解率（CR）和2个部分缓解率（pr），总缓解率（ORR）为57.1%，1名患者的持久CR持续了至少20个月。总之，对于cd19靶向CAR-T治疗后进展的DLBCL患者，齐达胺联合辛替单抗可能是一种选择。
Diffuse large B-cell lymphoma (DLBCL) is curable with first-line chemoimmunotherapy but patients with relapsed/refractory (R/R) DLBCL still face a poor prognosis. For patients with R/R DLBCL, the complete response rate to traditional next-line therapy is only 7% and the median overall survival is 6.3 mo. Recently, CD19-targeting chimeric antigen receptor T cells (CAR-T) have shown promise in clinical trials. However, approximately 50% of patients treated with CAR-T cells ultimately progress and few salvage therapies are effective. Here, we report on 7 patients with R/R DLBCL whose disease progressed after CAR-T infusion. They received a PD-1 inhibitor (sintilimab) and a histone deacetylase inhibitor (chidamide). Five of the 7 patients tolerated the treatment without any serious adverse events. Two patients discontinued the treatment due to lung infection and rash. At the 20-mo follow-up, the median overall survival of these 7 patients was 6 mo. Of note, there were 2 complete response rates (CRs) and 2 partial response rates (PRs) during this novel therapy, with an overall response rate (ORR) of 57.1%, and one patient had a durable CR that lasted at least 20 mo. In conclusion, chidamide combined with sintilimab may be a choice for DLBCL patients progressing after CD19-targeting CAR-T therapy.
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