Table 1:
Cytokine release syndrome, neurotoxicity and response rates in selected CD19 CAR-T cell trials.
Cell product | Malignancy | Study | Population | Costim-ulatory Domain | Lymphodepletion | Cell dose | CRS grading system | CRS Total/ severea | NT grading system | NT Total/ severeb | Best ORR/CR |
---|---|---|---|---|---|---|---|---|---|---|---|
Tisagenlecleucel | ALL | Maude, et al [6] | 75 pediatric/ young adult patients | 4-1BB | Flu/Cy in 71 patients and cytarabine/etoposide in 1 patientc | 0.2–5.4 x 106/kg | PENN grading [26] | 77%/47% | CTCAE 4.03[47] | 40%/13% | N/A/81% d |
Tisagenlecleucel | NHL | Schuster, et al [7] | 111 adult patients | 4-1BB | Flu 25mg/m2/day and Cy 250mg/m2/day x 3 days or Bendamustine 90mg/m2/day x 2 days |
0.1–6 x 108 | PENN grading | 58%/22% | CTCAE 4.03 | 21%/12% | 52%e/40% |
Axicabtagene ciloleucel | NHL | Neelapu, et al [2] | 101 adult patients | CD28 | Flu 30mg/m2/day and Cy 500mg/m2/day x 3 days | 2 x 106/kg | Lee, et al [25] | 93%/13% | CTCAE 4.03 | 64%/28% | 82%f/54% |
Lisocabtagene maraleucel | NHL | Abramson, et al [48,61] | 91 adult patients | 4-1BB | Flu 30mg/m2/day and Cy 300mg/m2/day x 3 days | 0.5–1 x 108 (1:1 ratio of CD4:CD8 CAR-T cells) |
Lee, et al | 35%/1% | CTCAE 4.03 | 19%/12% | 74%e/52% |
ALL - acute lymphoblastic leukemia
CRS - cytokine release syndrome
CTCAE - Common Terminology Criteria for Adverse Events
CR - complete response
Cy - cyclophosphamide
Flu - fludarabine
NT - neurotoxicity
ORR - overall response rate
NHL - non-Hodgkin's lymphoma
severe is grade 3 or higher, grading systems differ
CTCAE 4.03 grading criteria, severe is grade 3 or higher [47]
doses and duration not specified
minimal residual disease negative by flow cytometry with and without complete hematologic recovery
Lugano classification [59]
International Working Group Response Criteria for Malignant Lymphoma [60]