title: Chimeric antigen receptor T cells for sustained remissions in leukemia.
abstract: BACKGROUND
  Relapsed acute lymphoblastic leukemia (ALL) is difficult to treat despite the availability of aggressive therapies. Chimeric antigen receptor-modified T cells targeting CD19 may overcome many limitations of conventional therapies and induce remission in patients with refractory disease.
  
  
  METHODS
  We infused autologous T cells transduced with a CD19-directed chimeric antigen receptor (CTL019) lentiviral vector in patients with relapsed or refractory ALL at doses of 0.76×10(6) to 20.6×10(6) CTL019 cells per kilogram of body weight. Patients were monitored for a response, toxic effects, and the expansion and persistence of circulating CTL019 T cells.
  
  
  RESULTS
  A total of 30 children and adults received CTL019. Complete remission was achieved in 27 patients (90%), including 2 patients with blinatumomab-refractory disease and 15 who had undergone stem-cell transplantation. CTL019 cells proliferated in vivo and were detectable in the blood, bone marrow, and cerebrospinal fluid of patients who had a response. Sustained remission was achieved with a 6-month event-free survival rate of 67% (95% confidence interval [CI], 51 to 88) and an overall survival rate of 78% (95% CI, 65 to 95). At 6 months, the probability that a patient would have persistence of CTL019 was 68% (95% CI, 50 to 92) and the probability that a patient would have relapse-free B-cell aplasia was 73% (95% CI, 57 to 94). All the patients had the cytokine-release syndrome. Severe cytokine-release syndrome, which developed in 27% of the patients, was associated with a higher disease burden before infusion and was effectively treated with the anti-interleukin-6 receptor antibody tocilizumab.
  
  
  CONCLUSIONS
  Chimeric antigen receptor-modified T-cell therapy against CD19 was effective in treating relapsed and refractory ALL. CTL019 was associated with a high remission rate, even among patients for whom stem-cell transplantation had failed, and durable remissions up to 24 months were observed. (Funded by Novartis and others; CART19 ClinicalTrials.gov numbers, NCT01626495 and NCT01029366.).
authors.affiliation: From the Division of Oncology, Children's Hospital of Philadelphia (S.L.M., R.A., D.M.B., N.J.B., S.R.R., D.T.T., S.A.G.), the Departments of Pediatrics (S.L.M., R.A., D.M.B., N.J.B., S.R.R., D.T.T., S.A.G.), Biostatistics and Epidemiology (P.A.S., R.A.), and Pathology and Laboratory Medicine (J.J.M., B.L.L., C.H.J., S.A.G.), the Division of Hematology-Oncology (N.F., D.L.P.), and Abramson Cancer Center (N.F., A.C., V.E.G., Z.Z., S.F.L., Y.D.M., J.J.M., B.L.L., C.H.J., D.L.P., S.A.G.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; and Novartis Pharmaceuticals, East Hanover, NJ (A.S.).
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Maude
authors.forename: Noelle
authors.initials: N
authors.lastname: Frey
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Shaw
authors.forename: Richard
authors.initials: R
authors.lastname: Aplenc
authors.forename: David M
authors.initials: DM
authors.lastname: Barrett
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Bunin
authors.forename: Anne
authors.initials: A
authors.lastname: Chew
authors.forename: Vanessa E
authors.initials: VE
authors.lastname: Gonzalez
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Zheng
authors.forename: Simon F
authors.initials: SF
authors.lastname: Lacey
authors.forename: Yolanda D
authors.initials: YD
authors.lastname: Mahnke
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Melenhorst
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rheingold
authors.forename: Angela
authors.initials: A
authors.lastname: Shen
authors.forename: David T
authors.initials: DT
authors.lastname: Teachey
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Levine
authors.forename: Carl H
authors.initials: CH
authors.lastname: June
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Grupp
mesh_terms: D000293:Adolescent; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018941:Antigens, CD19; D002648:Child; D002675:Child, Preschool; D002678:Chimera; D016207:Cytokines / Q000097:blood; D005260:Female; D005818:Genetic Engineering; D015316:Genetic Therapy; D005822:Genetic Vectors; D006801:Humans; D007167:Immunotherapy; D016086:Lentivirus / Q000235:genetics; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D011948:Receptors, Antigen, T-Cell / Q000235:genetics / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018941:Antigens, CD19; D016207:Cytokines; D011948:Receptors, Antigen, T-Cell; C502936:tocilizumab