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Inquiring the potential of donor derived CD19-CAR TSCM to treat B-cell malignancies.

Relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT) is associated with poor survival in advanced B-cell malignancies. Donor-derived CD19-CAR T cells offer the potential for durable remissions but are limited by poor engraftment, expansion, and persistence. We report results from a sequential Phase 1 study (NCT01087294) in which patients with B-cell malignancies relapsed after alloHSCT received either donor-derived standard or stem cell memory T (TSCM)-enriched CD19-CAR T cells without lymphodepletion preconditioning. CAR TSCM cells exhibited delayed but superior expansion and persistence, leading to higher complete remission rates (45% vs. 10%) for doses < 3×108 CAR T cells. Despite their potency, CAR TSCM cells induced milder cytokine-mediated toxicities, driven by IFN-γ rather than IL-6, as observed in standard CAR T cell recipients. While both T cell products differentiated into effectors, only CAR TSCM cells robustly reconstituted the stem-like compartment. Longitudinal clonal-tracking revealed CAR TSCM cells were maintained by clonal succession, whereas standard CAR T cells persisted through maintenance or attrition of early-expanded clones. Unlike standard CAR T cells, CAR TSCM treatment failure was primarily due to tumor- and host-related factors rather than intrinsic T cell defects. These findings establish TSCM cells as a safe and highly effective CAR T cell platform.

Type: Other
Archiver: European Genome-phenome Archive (EGA)

1 Dataset

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Dataset ID	Description	Technology	Samples
EGAD00001015540	Integration site analysis (ISA) was performed using a previously described non-restrictive vector-genome Junction amplification method combined with high-throughput sequencing59. Briefly, amplified gDNA was fragmented by sonication to generate ~1000 bp fragments and ligated to a linker cassette (LC) with a known sequence. Two rounds of exponential PCRs (35 cycles each) were conducted using primers specific to the vector long terminal repeats (LTRs) and the LCs. A final PCR step introduced Illumina adapter sequences and a unique index for each sample, enabling multiplexing for next-generation sequencing on the Illumina NextSeq 2000. A set of 24 fusion PCR primers was designed to bind the vector LTR, and a set of 24 fusion PCR primers designed to bind the LC (all primers were purchased from Integrated DNA Technology). Fusion PCR products were purified, quantified, and pooled in an equimolar fashion. Prepared pooled libraries were quantified and loaded onto the Illumina NextSeq 2000. Sequencing reads were demultiplexed based on the sample-specific indices and analysis of sequencing reads including mapping and annotation to the human genome (hg18 version) was performed using the IS-Seq bioinformatic pipeline.	NextSeq 2000	2