MVP COMBINED WITH FC AS LYMPHOCYTE-DEPLETING CHEMOTHERAPY BEFORE CAR-T TREATMENT CAN REDUCE THE INCIDENCE OF SEVERE CYTOKINE RELEASE SYNDROME FOR R/R ALL PATIENTS WITH HIGH TUMOUR BURDEN
Author(s): ,
Xiaowen Tang
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Qian Liu
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China;The Third People's Hospital of Kunshan,Kunshan,China
,
Zheng Li
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Haiping Dai
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Jia Yin
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Xiaopeng Tian
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Shengli Xue
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Yang Xu
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
,
Xiaming Zhu
Affiliations:
Jiangsu Institute of Hematology,Suzhou,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China
Depei Wu
Affiliations:
Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,China;Jiangsu Institute of Hematology,Suzhou,China
EHA Library. Tang X. Jun 15, 2019; 267260; PS959
Xiaowen Tang
Xiaowen Tang
Contributions
Abstract

Abstract: PS959

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
CAR-T immunotherapy have shown remarkable promising results for relapsed/ refractory (R/R) acute lymphoblastic leukemia(ALL). However, the most common toxicity associated with CD19 CAR-T treatment is Cytokine Release Syndrome(CRS) which can be a life threatening complication especially for high tumour burden ALL patients. How to reduce the incidence of severe CRS can be a great challenge for advanced high tumour patients.

Aims
In order to evaluate the efficacy and safety of MVP+FC as lymphocyte-depleting chemotherapy to reduce tumour burden before CAR-T therapy. 

Methods
If patients’ blasts in bone marrow was more than 28%, the chemotherapy MVP(Mitoxantrone 10mg/w once(d1)+ Vindesine 4mg/w once(d1) + Dexamethasone 10mg/d×7d(d1-d7)followed by FC(Fludarabine 30mg/m× 3d (d8- d10)+ cyclophosphamide 300mg/m2×3d(d8-d10))were performed. CD19 CAR-T, CD22CAR-T and CD19CD22 tandem CAR-T were infused with dose escalation schedule: 10%>- 40%>- 60% (d13, d14, d15). Total dose of CAR-T for infusion was 5-10×106/kg. 

Results
16 patients were enrolled in this study with median age of 24 ( 6-56) years old. 11 patients were relapse post multiple chemotherapies. Another 5 patients were relapse post allo-HSCT including T315I and TP53 mutation patients. The median blasts in BM before and after MVP treatment were 56% (28-89%) and 34%(0-85%).Furthermore, the median blasts in BM after MVP+FC treatment were 6%(0-60.5%). Overall response of CAR-T were 93.75% with hematological remission 93.75% and molecular remission 63.75%.Only 4 patients experienced 3 grade CRS and other patients just had 1-2 grade of CRS. Only one presented sepsis.No one experienced neurotoxicity. Treatment related mortality was 0.With the median follow up of 9(1-26)months, 6 and 12 months leukemia free survival were 56.9% and 40.6% respectively. 

Conclusion
MVP combined with FC was an effective and safety conditionning regimen before CAR-T treatment with low incidence of severe CRS especially for high tumour burden ALL patients. 

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Relapsed acute lymphoblastic leukemia

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