针对患有治疗不耐药自身免疫疾病的儿科患者的抗CD19CAR T细胞
Marco Becilli1, Markus Metzler2,3, Claudia Bracaglia4
1Department of Hematology/Oncology, Cell and Gene Therapy, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Bambino Gesù Children's Hospital, Rome, Italy.
Nature medicine
|February 5, 2026
概括
化学抗原受体 (CAR) T细胞疗法对患有严重自身免疫性疾病 (ADs) 的儿童显示出希望. 一系列病例发现CD19 CAR T细胞 (zorpocabtagene autoleucel) 导致显著的疾病改善和B细胞枯竭,并具有可控的副作用.
科学领域:
- 免疫学 免疫学 免疫学
- 细胞疗法细胞疗法
- 自免疫性疾病 自免疫性疾病
背景情况:
- 化学抗原受体 (CAR) T细胞疗法是一种新的方法,用于B细胞介导的自身免疫性疾病 (ADs) 耐标准治疗.
- 在儿童中,严重/耐药性ADs由于有限的治疗选择,造成了重大挑战.
研究的目的:
- 评估自主CD19CART细胞 (zorpocabtagene autoleucel) 在患有严重/耐药性AD的儿童中的安全性和有效性.
- 评估医院豁免 (HE) 计划下医疗点制造和治疗的可行性.
主要方法:
- 一个病例系列,八名患有严重/耐药性ADS的儿童 (全身性红斑狼,皮肤肌炎,全身性硬化症) 用单次注射zorpocabtagene autoleucel治疗.
- 通过医院豁免 (HE) 计划进行的治疗,允许在单个患者基础上使用先进治疗药物 (ATMP).
- 监测CAR T细胞扩张,B细胞枯竭,不良事件 (细胞因子释放综合征,神经毒性,血液毒性) 和临床疾病活性.
主要成果:
- 在所有患者中,成功地在护理中心制造出全身性CD19 CAR T细胞.
- 所有患者在输液后都经历了迅速的B细胞清除和体内CAR T细胞扩张.
- 可管理的不良事件包括1级细胞因子释放综合征 (6/8) 和1级免疫效应细胞相关的神经毒性综合征 (1/8);有限的晚期血毒性 (1分之2/8级). 没有发生严重的感染.
- 所有患者都表现出显著的临床改善/阿尔茨海默病的解决,随访时间中位数为16.5个月,使得免疫调节剂的持续停用成为可能.
结论:
- 佐尔波卡巴泰根自动治疗是一种潜在的安全和有效的治疗方法,用于患有严重/耐药自身免疫性疾病的儿童.
- 医院豁免 (HE) 途径为缺乏其他选择的儿科患者提供了先进治疗药物 (ATMP).
- 迫切需要正式的临床试验来证实这些初步发现,并评估儿童群体的长期安全性和有效性.
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