在大脑上腺核胆固醇缩的基因疗法后,血液癌症
Christine N Duncan1, Jacob R Bledsoe1, Bartosz Grzywacz1
1From Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School (C.N.D., D.A.W.), the Department of Pathology, Boston Children's Hospital (J.R.B., M.H.H.), and Massachusetts General Hospital and Harvard Medical School (F.S.E.) - all in Boston; the Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center (B.G., A.B.), and the Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota (A.O.G., P.J.O.) - both in Minneapolis; Bluebird Bio, Somerville, MA (M.B., S.S., R.A.C., V.K.P., G.F.D., F.J.P., M.A.K., M.F., A.L., N.F., G.P., A.C.D., H.L.T.); the Department of Pediatric Oncology, Hematology and Hemostaseology, Leipzig University Hospital, Leipzig, Germany (J.-S.K.); and the Division of Pediatric Transplant and Cellular Therapy, Duke University School of Medicine, Durham, NC (V.K.P.).
使用elivaldogene autotemcel (eli-cel) 治疗大脑上腺细胞衰竭的基因治疗显示出有效性,但存在风险. 由于载体插入和遗传突变,一些患者患有血液癌症.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 基因治疗 基因治疗
- 分子生物学分子生物学
背景情况:
- 使用带有ABCD1cDNA的lentiviral载体的elivaldogene autotemcel (eli-cell) 基因疗法,已在治疗大脑 adrenoleukodystrophy方面表现出有效性.
- 与eli-cel治疗相关的潜在致癌风险仍然是临床关注的领域.
研究的目的:
- 为了调查elivaldogene自细胞 (eli-cell) 基因疗法的致癌风险.
- 为了分析集成部位和基因变化,在患者谁开发了血液恶性瘤后,eli-cell治疗.
主要方法:
- 在外周血液和骨髓样本上进行了整合部位分析,遗传研究,流细胞计和形态评估.
- 从参与eli-cel临床试验 (ALD-102,ALD-104) 和后续研究 (LTF-304) 的患者收集了数据.
主要成果:
- 在67名患者中,有7人患有血液癌症,包括骨髓质疏松症候群 (MDS) 和急性骨髓性白血病 (AML).
- 受影响患者中占主导地位的克隆显示了在MECOM-EVI1和PRDM16等瘤基因的晶状病毒载体插入,以及体质突变 (例如,KRAS,NRAS,WT1).
- 异构造造血干细胞移植 (HSCT) 在大多数MDS患者中导致缓解,而AML患者实现了捐赠者嵌合体.
结论:
- 在接受eli-cel治疗的小组患者中的血液恶性瘤与瘤基因中的克隆载体插入以及随后的遗传缺陷的获得有关.
- 这些发现强调了持续监测基因疗法接受者的瘤发生的重要性.
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