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Updated: Feb 13, 2026

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Studying Interactions between Myeloid Cells and CAR T Cells In Vitro and In Vivo
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標準化プロトコルを使用したCD28共刺激性抗CD19CAR-T細胞で治療された高リスク高齢患者のICANS緩和:パイロット試験
Gil Fridberg1, Odelia Amit2, Yehonathan Sherf3
1BMT and Cellular Therapy Unit, Hematology Division, Aviv Sourasky Medical Center; Gray Faculty of Medical and Health Sciences, Aviv University, Aviv. gilfr@tlvmc.gov.il.
Haematologica
|February 12, 2026
まとめ
レベチラセタム,チアミン,および初期のステロイド/アナキンラを使用した新しいプロトコルは,LBCLに対するCD28ベースのCAR-T治療を受けている高齢者の神経毒性 (ICANS) 期間を短縮しました.
科学分野:
- 腫瘍学 腫瘍学
- 神経学 神経学とは
- 免疫療法による免疫療法です.
背景:
- 化学抗原受容体T細胞 (CAR-T) 療法,特にCD28ベースの製品は,再発 / 耐性の大型B細胞リンパ腫 (LBCL) 治療に革命をもたらしました.
- しかし,これらの治療は,特に特定の緩和戦略が欠如している高齢者の免疫エフェクター細胞関連神経毒性症候群 (ICANS) の高率と関連しています.
- 既存のデータは,承認されたCD28ベースのCAR-T剤で全体および重度のICANS率が78%および35%であることを示しています.
研究 の 目的:
- CD28ベースの抗CD19 CAR-T療法を受けている高齢者に合わせた標準化されたICANS緩和プロトコルの開発と実装.
- この脆弱な患者集団における神経毒性の管理に関する満たされていない重大なニーズに対処するためです.
主な方法:
- 75歳以上の患者,または追加のリスク因子を持つ65歳以上の患者で,CD28ベースのCAR-T.を投与した単一アームの予見試験試験が行われました.
- プロトコルはレベチラセタムとチアミン予防を組み込んだ.
- 早期,グレードベースのコルチコステロイドとアナキンラ投与は,グレード3以上の耐火性ICANS (24時間以内に改善がないと定義される) に使用されました.
主要な成果:
- 45人の患者が登録され,平均年齢は75歳,78%はECOGパフォーマンスステータス2以上,42%は既にある神経学的併発症でした.
- このプロトコルにより,総合,グレード3以上,および耐火性ICANS率はそれぞれ67%,31%,20%となった.
- ICANSの平均期間は4日であり,歴史的なコホートと比較して短かった. 疾患の特徴はICANSの指標を予測することはできませんでしたが,LDHはICANSが重症になる傾向を示しました.
結論:
- 実施された標準化されたプロトコルは,CD28ベースのCAR-T療法を受けている高齢者のICANSの期間を効果的に短縮しました.
- この発見は,積極的な神経保護戦略が,脆弱な高齢者集団におけるCAR-T関連の神経毒性を軽減できることを示唆しています.
- これらの発見を確認し,管理戦略を最適化するために,累積的なステロイドの感染の増加と非再発死亡率との関連を考慮して,さらなる研究が必要である.
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