对于严重状细胞疾病的ExagamglogeneAutotemcel
Haydar Frangoul1, Franco Locatelli1, Akshay Sharma1
1From Sarah Cannon Research Institute at the Children's Hospital at TriStar Centennial (H.F.), Nashville, and Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis (A.S.) - both in Tennessee; IRCCS, Ospedale Pediatrico Bambino Gesù, Catholic University of the Sacred Heart, Rome (F.L.); the Department of Pediatrics, Columbia University Irving Medical Center, New York-Presbyterian-Morgan Stanley Children's Hospital (M.B.), and the Department of Medicine, Division of Hematology-Oncology, Columbia University (M. Mapara) - both in New York; Sarah Cannon Pediatric Transplant and Cellular Therapy Program at Methodist Children's Hospital, San Antonio, TX (L.M., M.J.E.); the Hospital for Sick Children and the University of Toronto, Toronto (D.W.); Ann and Robert H. Lurie Children's Hospital of Chicago (R.I.L.) and the University of Illinois at Chicago (D.R.) - both in Chicago; Royal London Hospital, Barts Health NHS Trust, London (P.T.); Stanford University, Palo Alto (A.J.S.), and University of California San Francisco Benioff Children's Hospital, Oakland (M.C.W.) - both in California; the Biotherapy Department and Biotherapy Clinical Investigation Center (M.C.), Necker-Enfants Malades Hospital, Assistance Publique-Hopitaux de Paris, Université Paris-Cité (M. de Montalembert), Paris; the University of Regensburg, Regensburg (S.C.), the Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Heinrich Heine University, Duesseldorf (R.M.), and Gemeinschaftsklinikum Mittelrhein, Koblenz (S.L.) - all in Germany; Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels (L.D.); Boston University Chobanian and Avedisian School of Medicine (M.H.S.) and Vertex Pharmaceuticals (S.I., L.B., C.S., W.Z., F.X., W.E.H.), Boston, and CRISPR Therapeutics, Cambridge (P.K.M.) - all in Massachusetts; and the Division of Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (S.A.G.).
在12个多月的时间里,exagamglogene autotemcel (exa-cel) 基因疗法有效地消除了97%的状细胞病患者的严重血管闭塞危机. 这种开创性的治疗方法为状细胞疾病管理提供了新的治疗选择.
科学领域:
- 血液学 血液学 血液学
- 基因治疗 基因治疗
- 细胞医学是细胞医学.
背景情况:
- 埃克萨-塞尔 (exa-cel) 是一种使用CRISPR-Cas9基因编辑的新型非病毒细胞疗法.
- 它向自身的CD34+造血干细胞和原生细胞 (HSPCs),以重新激活胎儿血红蛋白合成.
- 编辑的重点是BCL11A基因的红状腺特异性增强器区域.
研究的目的:
- 评估exa-cel在患有状细胞病的患者中的疗效和安全性.
- 评估主要终点,即至少连续12个月没有严重的血管封闭性危机.
- 确定二次终点,即至少连续12个月不需要住院治疗严重血管闭塞危机.
主要方法:
- 进行了第三阶段,单组,开放标签研究.
- 参与者是12至35岁的病人,患有状细胞疾病,有严重血管闭塞危机的病史.
- 使用CRISPR-Cas9编辑了HSPCs,随后进行了骨髓修复性busulfan调节和exa-cel输液.
主要成果:
- 总共有44名患者接受了exa-cel,随访时间中位数为19.3个月.
- 97%的可评估患者 (29/30) 在至少12个月内没有血管闭塞危机.
- 100%的可评估患者 (30/30) 在至少12个月内没有因血管封闭性危机而入院.
- 安全性概况与骨髓衰变条件和自身的HSPC移植相一致;没有报告的癌症.
结论:
- 埃克萨塞尔治疗在消除状细胞病患者血管封闭性危机方面表现出高效.
- 该疗法实现了持续的免于严重的血管封闭性危机和至少12个月的住院治疗.
- 埃克萨塞尔在治疗状细胞疾病方面取得了重大进展.
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