The efficacy and safety of anti-CD19/CD20 chimeric antigen receptor- T cells immunotherapy in relapsed or refractory B-cell malignancies:a meta-analysis

BMC Cancer. 2018 Sep 26;18(1):929. doi: 10.1186/s12885-018-4817-4.

Abstract

Background: Chimeric antigen receptor T (CAR T) cells immunotherapy is rapidly developed in treating cancers, especially relapsed or refractory B-cell malignancies.

Methods: To assess the efficacy and safety of CAR T therapy, we analyzed clinical trials from PUBMED and EMBASE.

Results: Results showed that the pooled response rate, 6-months and 1-year progression-free survival (PFS) rate were 67%, 65.62% and 44.18%, respectively. We observed that received lymphodepletion (72% vs 44%, P = 0.0405) and high peak serum IL-2 level (85% vs 31%, P = 0.04) were positively associated with patients' response to CAR T cells. Similarly, costimulatory domains (CD28 vs CD137) in second generation CAR T was positively associated with PFS (52.69% vs 33.39%, P = 0.0489). The pooled risks of all grade adverse effects (AEs) and grade ≥ 3 AEs were 71% and 43%. Most common grade ≥ 3 AEs were fatigue (18%), night sweats (14%), hypotension (12%), injection site reaction (12%), leukopenia (10%), anemia (9%).

Conclusions: In conclusion, CAR T therapy has promising outcomes with tolerable AEs in relapsed or refractory B-cell malignancies. Further modifications of CAR structure and optimal therapy strategy in continued clinical trials are needed to obtain significant improvements.

Keywords: Chimeric antigen receptor T (CAR T) therapy; Efficacy; Relapsed or refractory B-cell malignancies; Safety.

Publication types

  • Meta-Analysis

MeSH terms

  • Antigens, CD19 / immunology*
  • Antigens, CD20 / immunology*
  • Clinical Trials as Topic
  • Female
  • Humans
  • Immunotherapy
  • Immunotherapy, Adoptive / adverse effects
  • Immunotherapy, Adoptive / methods*
  • Leukemia, B-Cell / immunology
  • Leukemia, B-Cell / therapy*
  • Lymphoma, B-Cell / immunology
  • Lymphoma, B-Cell / therapy*
  • Male
  • Progression-Free Survival
  • Receptors, Chimeric Antigen
  • Recurrence
  • Survival Analysis
  • Treatment Outcome

Substances

  • Antigens, CD19
  • Antigens, CD20
  • CD19 molecule, human
  • Receptors, Chimeric Antigen