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目的探索嵌合抗原受体T细胞(CAR-T细胞)治疗复发/难治性急性B淋巴细胞白血病的效果。方法回顾性分析本院2015年4月-2016年1月3例复发/难治性急性B淋巴细胞白血病患者采用CAR-T细胞治疗的临床疗效。3例患者均为多次诱导化疗不能达到完全缓解,或复发后再次诱导治疗无效。均采集自体外周血T淋巴细胞进行转染、培养。回输前以氟达拉滨+环磷酰胺方案预处理,回输CAR-T细胞数量为0.97至1.0×106/kg。结果2例患者在CAR-T细胞输注后1月内达到完全缓解,1例患者无效。达到缓解的2例患者在CAR-T细胞治疗后的第3和第6个月复发。复发后的1例患者出现CD19阴性克隆复发;在整个治疗过程中,未发生严重的不良反应。结论 CAR-T细胞是治疗复发/难治CD19抗原阳性急性淋巴细胞白血病的有效方法,能够降低耐药患者体内肿瘤负荷,甚至达到完全缓解,但短期内复发较高且复发的白血病细胞可能出现CD19抗原缺失。因此,在临床的应用方法还需要进行临床研究,也可作为异基因造血干细胞移植前的桥接治疗。
Objective To explore the effect of chimeric antigen receptor T cells (CAR-T cells) on relapsed / refractory acute lymphoblastic leukemia. Methods A retrospective analysis of our hospital from April 2015 to January 2016 3 cases of relapsed / refractory acute lymphoblastic leukemia patients with CAR-T cells in the treatment of clinical efficacy. All three patients failed to achieve complete remission after repeated induction chemotherapy or relapse induction therapy after relapse. All peripheral blood T lymphocytes were collected for transfection and culture. Pretreatment with fludarabine + cyclophosphamide regimen before reinfusion, the number of CAR-T cells transfused was 0.97 to 1.0 × 10 6 / kg. Results Two patients achieved complete remission within one month after CAR-T cell infusion, and one patient was ineffective. Two patients who achieved remission relapsed at the third and sixth months after CAR-T cell treatment. One patient developed recurrent CD19 negative clones recurrence; no serious adverse reactions occurred during the course of treatment. Conclusion CAR-T cells are an effective method to treat relapsed / refractory CD19 antigen-positive acute lymphoblastic leukemia, which can reduce the tumor burden in patients with drug resistance and even achieve complete remission. However, the relapse and recurrence of CAR-T cells may occur in leukemia cells with CD19 Antigen is missing. Therefore, the clinical application of the method also needs clinical research, but also as a bridge before the allogeneic hematopoietic stem cell transplantation.