Sustained Remission of Relapsed or Refractory Mantle Cell Lymphoma After 4-1BB-Based CD19-Directed CAR-T Therapy

Abstract

Chunmei Yang,1,* Wen Lei,1,2,* Hongqiong Xie,1,* Gongqiang Wu,3 Juying Wei,1 Aibin Liang,4 Wenbin Qian1,2,5 1Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang, People’s Republic of China; 2Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang, People’s Republic of China; 3Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang, People’s Republic of China; 4Department of Hematology, Tongji Hospital of Tongji University, Shanghai 200065, People’s Republic of China; 5National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Aibin LiangDepartment of Hematology, Tongji Hospital of Tongji University, Shanghai, People’s Republic of ChinaEmail [email protected] QianDepartment of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of ChinaEmail [email protected]: Relapsed and refractory (R/R) mantle cell lymphoma (MCL) remains an incurable lymphoma with a poor prognosis. Recently, there are a few studies demonstrating the efficacy of anti-CD19 chimeric antigen receptor T (CAR-T) cell therapy in MCL, including ZUMA-2 study in which CD28-based CAR-T cells were used. However, long-term efficacy and safety associated with 4-1BB-based CAR-T therapy in MCL are not defined well. Here, we report three male patients with R/R classical MCL, who received CD19-directed 4-1BB CAR-T therapy and achieved complete remission, showed mild symptoms of cytokine-release syndrome (CRS) and had no neurological toxicity. During a follow-up of 24– 35 months, all three patients remained in complete remission. Persistent B-cell depletion was observed in two patients. Recovery of CD19+ polyclonal B cells was detected in one patient at 6 months after CAR-T cell infusion. Recovery of serum immunoglobulin, including IgG, IgA and IgM, was not observed in two patients at the last follow-up. Only one patient developed herpes zoster, and the other two patients had no serious infection. This is the first report about the efficacy, long-term remission and safety of CD19-directed 4-1BB CAR-T therapy in R/R MCL.Keywords: mantle cell lymphoma, CAR-T cell therapy, long-duration remission, B-cell depletion

Keywords

• mantle cell lymphoma
• car-t cell therapy
• long-duration remission
• b-cell depletion