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CD7-directed CAR-T cells are an investigational chimeric antigen receptor (CAR) T-cell immunotherapy designed to target the CD7 antigen, a transmembrane glycoprotein highly expressed on malignant T cells in T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL), as well as certain cases of acute myeloid leukemia (AML). A significant challenge in the development of these therapies is T-cell fratricide, as CD7 is also expressed on healthy T cells and natural killer (NK) cells. To overcome this, various engineering strategies are employed, including CRISPR/Cas9-mediated CD7 gene knockout, protein expression blockers for intracellular sequestration (epitope masking), or the selection of naturally CD7-negative T-cell populations. Clinical studies, such as those involving the PF381 construct, have demonstrated high rates of minimal residual disease (MRD)-negative complete remission in relapsed/refractory patients, although resistance through lineage plasticity (lineage switch to myeloid phenotype) has been identified as a potential escape mechanism.
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