Chimeric antigen receptor(CAR) T-cell therapy is effective in relapsed/refractory large B-cell lymphoma(LBCL), but evidence in elderly patients(≥70y) is limited. We compared outcomes of tisagenlecleucel(tisa-cel) and axicabtagene ciloleucel(axi-cel) and assessed prognostic factors. We analyzed 1,191 patients(aged ≥70y) reported to the EBMT(tisa-cel n=402; axi-cel n=789). Median follow-up was 22.7 months. Outcomes included cytokine release syndrome(CRS), immune effector cell-associated neurotoxicity syndrome(ICANS), overall survival(OS), progression-free survival(PFS), relapse incidence(RI), and non-relapse mortality(NRM). Multivariable models adjusted for age, sex, ECOG, disease status, prior transplantation, and year of infusion. Median age at infusion was 74y; 65.6% were aged 70-75y. Progressive disease at infusion was 59% vs 53% for tisa-cel and axi-cel(p=0.04). Tisa-cel patients were older(74.0 vs 73.7y, p=0.019). At day-30, CRS(any grade) occurred in 62% vs 77%(p.
Vanderson Rocha, J. Mooyaart, R. Ram et al.· Haematologica· 0 citations
BACKGROUND
Acute graft-versus-host disease (aGvHD) remains a major complication after allogeneic hematopoietic cell transplantation (alloHCT). Adoptive regulatory T-cell (Treg) therapy may suppress alloreactive T-cell responses, but clinical implementation has been limited by donor-specific manufacturing, prolonged ex vivo expansion, and logistical complexity.
OBJECTIVE
We developed ATreg, a cell therapy product consisting of gp120-activated, polyclonal Tregs derived from HLA-unmatched third-party donors. The primary objective was to assess the safety, tolerability and toxicity of ATreg, hypothesizing that this would be feasable and safe for aGvHD prevention early after alloHCT in patients with hematologic malignancies.
STUDY DESIGN
ATreg-001 is a first-in-human, prospective, open-label, single-arm, multi-center phase 1/2 trial (EU CT number 2024-516599-14-00) conducted at four German centers (Mainz, Dresden, Münster, Dortmund). ATreg was generated from standard non-mobilized apheresis products by Treg isolation followed by 16 hours of gp120-mediated activation in the presence of IL-2, without ex vivo expansion, thereby enhancing suppressive function and (potentially) enabling a therapeutic effect at substantially lower Treg doses. Ten patients received ATreg at 0.1-1.0 × 10⁶ cells/kg body weight on day +10 ± 5 after alloHCT, in addition to standard GvHD prophylaxis, in a dose-escalation design across three cohorts. ATreg was administered within 24 hours after manufacturing. The primary endpoint was the type, incidence, and severity of ATreg-related serious adverse events within 14 days after administration. Secondary endpoints included manufacturing feasibility, aGvHD incidence/severity within 100 days, engraftment, and infections.
RESULTS
ATreg administration was well tolerated, with no infusion-related toxicities or other safety signals attributable to ATreg. All treated patients achieved hematopoietic engraftment and full donor chimerism. Within 100 days after alloHCT, no grade 3-4 aGvHD occurred, the cumulative incidence of grade 2-4 aGvHD was 10%, and no non-relapse mortality was observed.
CONCLUSION
These first clinical data support the feasibility and favorable safety profile of ATreg, a third-party, gp120-activated Treg product requiring no ex vivo expansion, and warrant further evaluation in larger prospective clinical trials.
MAIN POINTS
A. Tuettenberg, L. Ruhnke, J. Schlöder et al.· Transplantation and Cellular...· 0 citations
Pegtarazimod reduced aGVHD in mice by suppressing pro inflammatory neutrophil effector functions and preserving enterocyte integrity and the clinical trial data support tolerability of pegtarazimod in aGVHD patients and further studies are needed to determine efficacy.
Verena Holzmüller, Jana Gawron, Ann-Cathrin Burk et al.· Journal of Clinical Investig...· 0 citations
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