3401
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Weinkove R, George P, Dasyam N, McLellan AD. Selecting costimulatory domains for chimeric antigen receptors: functional and clinical considerations. Clin Transl Immunology 2019; 8:e1049. [PMID: 31110702 PMCID: PMC6511336 DOI: 10.1002/cti2.1049] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/11/2022] Open
Abstract
Costimulatory signals are required to achieve robust chimeric antigen receptor (CAR) T cell expansion, function, persistence and antitumor activity. These can be provided by incorporating intracellular signalling domains from one or more T cell costimulatory molecules, such as CD28 or 4-1BB, into the CAR. The selection and positioning of costimulatory domains within a CAR construct influence CAR T cell function and fate, and clinical experience of autologous anti-CD19 CAR T cell therapies suggests that costimulatory domains have differential impacts on CAR T cell kinetics, cytotoxic function and potentially safety profile. The clinical impacts of combining costimulatory domains and of alternative costimulatory domains are not yet clearly established, and may be construct- and disease-specific. The aim of this review is to summarise the function and effect of established and emerging costimulatory domains and their combinations within CAR T cells.
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Affiliation(s)
- Robert Weinkove
- Cancer Immunotherapy Programme Malaghan Institute of Medical Research Wellington New Zealand.,Wellington Blood & Cancer Centre Capital & Coast District Health Board Wellington New Zealand.,Department of Pathology & Molecular Medicine University of Otago Wellington Wellington New Zealand
| | - Philip George
- Cancer Immunotherapy Programme Malaghan Institute of Medical Research Wellington New Zealand.,Wellington Blood & Cancer Centre Capital & Coast District Health Board Wellington New Zealand
| | - Nathaniel Dasyam
- Cancer Immunotherapy Programme Malaghan Institute of Medical Research Wellington New Zealand
| | - Alexander D McLellan
- Department of Microbiology and Immunology University of Otago Dunedin New Zealand
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3402
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Hunter BD, Chen YB, Jacobson CA. Allogeneic Stem Cell Transplantation and Chimeric Antigen Receptor (CAR) T-Cell Therapy for the Treatment of Non-Hodgkin Lymphoma. Hematol Oncol Clin North Am 2019; 33:687-705. [PMID: 31229163 DOI: 10.1016/j.hoc.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite the myriad of available treatments, a substantial subset of patients with non-Hodgkin lymphoma are not able to achieve a prolonged disease-free interval with conventional chemotherapy or targeted agents. For these patients, hematopoietic stem cell transplantation remains an option for consolidative or curative treatment. Additionally, chimeric antigen receptor T-cell therapy has emerged for patients with relapsed/refractory B-cell lymphomas. Published studies vary widely in their selected approach to transplant and cellular therapies. This review summarizes available data related to allogeneic hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy for the treatment of non-Hodgkin lymphomas.
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Affiliation(s)
- Bradley D Hunter
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA.
| | - Yi-Bin Chen
- Massachusetts General Hospital, 0 Emerson Place, Suite 118, Boston, MA 02114, USA
| | - Caron A Jacobson
- Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
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3403
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Di Vito C, Mikulak J, Zaghi E, Pesce S, Marcenaro E, Mavilio D. NK cells to cure cancer. Semin Immunol 2019; 41:101272. [PMID: 31085114 DOI: 10.1016/j.smim.2019.03.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Abstract
Natural Killer (NK) cells are innate lymphocytes able to mediate immune-surveillance and clearance of viral infected and tumor-transformed cells. Growing experimental and clinical evidence highlighted a dual role of NK cells either in the control of cancer development/progression or in promoting the onset of immune-suppressant tumor microenvironments. Indeed, several mechanisms of NK cell-mediated tumor escape have been described and these includes cancer-induced aberrant expression of activating and inhibitory receptors (i.e. NK cell immune checkpoints), impairments of NK cell migration to tumor sites and altered NK cell effector-functions. These phenomena highly contribute to tumor progression and metastasis formation. In this review, we discuss the latest insights on those NK cell receptors and related molecules that are currently being implemented in clinics either as possible prognostic factors or therapeutic targets to unleash NK cell anti-tumor effector-functions in vivo. Moreover, we address here the major recent advances in regard to the genetic modification and ex vivo expansion of anti-tumor specific NK cells used in innovative adoptive cellular transfer approaches.
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Affiliation(s)
- Clara Di Vito
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Joanna Mikulak
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Italy
| | - Elisa Zaghi
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Silvia Pesce
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Emanuela Marcenaro
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Italy.
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3404
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Culos K, Byrne M. Salvage Therapy after Allogeneic Hematopoietic Cell Transplantation: Targeted and Low-Intensity Treatment Options in Myelodysplastic Syndrome and Acute Myeloid Leukemia. Clin Hematol Int 2019; 1:94-100. [PMID: 34595416 PMCID: PMC8432395 DOI: 10.2991/chi.d.190503.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 11/01/2022] Open
Abstract
Patients with high-risk myeloid neoplasms, including myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), are offered allogeneic hematopoietic cell transplantation (alloHCT) to improve the likelihood of long-term disease control. More than 50% of patients with high-risk disease will relapse after HCT and face a poor prognosis with shortened survival. The recent development of targeted therapies and effective, low-intensity treatment strategies will likely improve the outcomes of these patients. In MDS, hypomethylating agents (HMAs) are the mainstay of salvage therapy but new treatments with APR-246 and luspatercept demonstrate excellent results in phase 1 and phase 3 clinical studies, respectively. In AML, new directed agents in the relapsed/refractory setting include gilteritinib (FLT3-ITD/-TKD), ivosidenib (IDH1), and enasidenib (IDH2). In patients without targetable mutations, HMAs may be used, and early data with venetoclax-based regimens are encouraging.
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Affiliation(s)
- Katie Culos
- Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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3405
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Baeuerle PA, Ding J, Patel E, Thorausch N, Horton H, Gierut J, Scarfo I, Choudhary R, Kiner O, Krishnamurthy J, Le B, Morath A, Baldeviano GC, Quinn J, Tavares P, Wei Q, Weiler S, Maus MV, Getts D, Schamel WW, Hofmeister R. Synthetic TRuC receptors engaging the complete T cell receptor for potent anti-tumor response. Nat Commun 2019; 10:2087. [PMID: 31064990 PMCID: PMC6504948 DOI: 10.1038/s41467-019-10097-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 12/30/2022] Open
Abstract
T cells expressing CD19-targeting chimeric antigen receptors (CARs) reveal high efficacy in the treatment of B cell malignancies. Here, we report that T cell receptor fusion constructs (TRuCs) comprising an antibody-based binding domain fused to T cell receptor (TCR) subunits can effectively reprogram an intact TCR complex to recognize tumor surface antigens. Unlike CARs, TRuCs become a functional component of the TCR complex. TRuC-T cells kill tumor cells as potently as second-generation CAR-T cells, but at significant lower cytokine release and despite the absence of an extra co-stimulatory domain. TRuC-T cells demonstrate potent anti-tumor activity in both liquid and solid tumor xenograft models. In several models, TRuC-T cells are more efficacious than respective CAR-T cells. TRuC-T cells are shown to engage the signaling capacity of the entire TCR complex in an HLA-independent manner.
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MESH Headings
- Animals
- Antigens, CD19/immunology
- Antigens, Neoplasm/immunology
- Cell Line, Tumor
- Female
- Humans
- Immunotherapy, Adoptive/methods
- Mice
- Mice, Inbred NOD
- Neoplasms/immunology
- Neoplasms/therapy
- Primary Cell Culture
- Protein Domains
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Artificial/genetics
- Receptors, Artificial/immunology
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/immunology
- Single-Chain Antibodies/genetics
- Single-Chain Antibodies/immunology
- T-Lymphocytes/immunology
- Treatment Outcome
- Xenograft Model Antitumor Assays
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Affiliation(s)
| | - Jian Ding
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Ekta Patel
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Niko Thorausch
- Department of Immunology, Faculty of Biology, BIOSS Center for Biological Signalling Studies, CIBSS-Centre for Integrative Biological Signalling Studies and Centre for Chronic Immunodeficiency CCI, University of Freiburg, Schänzlestraβe 18, Freiburg, 79104, Germany
| | - Holly Horton
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Jessica Gierut
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Irene Scarfo
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center and Harvard Medical School, Bldg. 149 13th Street, Charlestown, MA, USA
| | - Rashmi Choudhary
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Olga Kiner
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | | | - Bonnie Le
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Anna Morath
- Department of Immunology, Faculty of Biology, BIOSS Center for Biological Signalling Studies, CIBSS-Centre for Integrative Biological Signalling Studies and Centre for Chronic Immunodeficiency CCI, University of Freiburg, Schänzlestraβe 18, Freiburg, 79104, Germany
| | | | - Justin Quinn
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Patrick Tavares
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Qi Wei
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Solly Weiler
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center and Harvard Medical School, Bldg. 149 13th Street, Charlestown, MA, USA
| | - Daniel Getts
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA
| | - Wolfgang W Schamel
- Department of Immunology, Faculty of Biology, BIOSS Center for Biological Signalling Studies, CIBSS-Centre for Integrative Biological Signalling Studies and Centre for Chronic Immunodeficiency CCI, University of Freiburg, Schänzlestraβe 18, Freiburg, 79104, Germany
| | - Robert Hofmeister
- TCR² Therapeutics, Inc., 100 Binney Street, Cambridge, MA, 02142, USA.
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3406
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Jiang H, Liu L, Guo T, Wu Y, Ai L, Deng J, Dong J, Mei H, Hu Y. Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy. Ann Hematol 2019; 98:1721-1732. [PMID: 31055613 DOI: 10.1007/s00277-019-03685-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
The CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy has been widely proved effective on relapsed and refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL). Meanwhile, CAR-T therapy-related toxicities, including cytokine release syndrome (CRS) and neurological toxicities, are drawing researchers' attention. In addition, our research team notices that coagulopathy and even disseminated intravascular coagulation (DIC) are common problems during CAR-T therapy. In our phase 1/2 clinical trial (NCT02965092), 53 r/r B-ALL patients underwent leukapheresis on day - 11 and received lymphodepleting chemotherapy on day - 7 to day - 5. Finally, they received split infusions of anti-CD19 CAR-T cells on day 0 to day 2. Plasma concentrations of tissue factor (TF) and platelet endothelial cell adhesion molecular-1 (PECAM-1) were also measured to identify the mechanism of coagulation disorders. The overall 1-month remission rate of the 53 patients was 88.7%. During the treatment course, 19 patients experienced grade 3-4 CRS, 8 patients developed grade 2-3 neurological toxicities. Beyond that, 30 patients (30/53, 56.6%) suffered from coagulation disorders, and half of them should be diagnosed as DIC. Benefiting from replacement and anticoagulant therapy, 14 patients successfully got out of the conditions of DIC. Remarkably, the severity of coagulopathy was positively correlated with CRS grade. What is more, plasma TF and PECAM-1 levels indicated that vascular endothelial factors played key roles in the process of CRS-related coagulopathy. To conclude, coagulation disorders frequently happen during CAR-T therapy. TF and PECAM-1 are of great importance in the etiology and pathogenesis of coagulation problems. Early and proper interventions targeted at CRS-related coagulopathy contribute a lot to the control of side effects in CAR-T therapy.
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Affiliation(s)
- Huiwen Jiang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
| | - Lin Liu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tao Guo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
| | - Yaohui Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
| | - Lisha Ai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
| | - Jian Dong
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. .,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. .,Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China.
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3407
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Raje N, Berdeja J, Lin Y, Siegel D, Jagannath S, Madduri D, Liedtke M, Rosenblatt J, Maus MV, Turka A, Lam LP, Morgan RA, Friedman K, Massaro M, Wang J, Russotti G, Yang Z, Campbell T, Hege K, Petrocca F, Quigley MT, Munshi N, Kochenderfer JN. Anti-BCMA CAR T-Cell Therapy bb2121 in Relapsed or Refractory Multiple Myeloma. N Engl J Med 2019; 380:1726-1737. [PMID: 31042825 PMCID: PMC8202968 DOI: 10.1056/nejmoa1817226] [Citation(s) in RCA: 1107] [Impact Index Per Article: 221.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preclinical studies suggest that bb2121, a chimeric antigen receptor (CAR) T-cell therapy that targets B-cell maturation antigen (BCMA), has potential for the treatment of multiple myeloma. METHODS In this phase 1 study involving patients with relapsed or refractory multiple myeloma, we administered bb2121 as a single infusion at doses of 50×106, 150×106, 450×106, or 800×106 CAR-positive (CAR+) T cells in the dose-escalation phase and 150×106 to 450×106 CAR+ T cells in the expansion phase. Patients had received at least three previous lines of therapy, including a proteasome inhibitor and an immunomodulatory agent, or were refractory to both drug classes. The primary end point was safety. RESULTS Results for the first 33 consecutive patients who received a bb2121 infusion are reported. The data-cutoff date was 6.2 months after the last infusion date. Hematologic toxic effects were the most common events of grade 3 or higher, including neutropenia (in 85% of the patients), leukopenia (in 58%), anemia (in 45%), and thrombocytopenia (in 45%). A total of 25 patients (76%) had cytokine release syndrome, which was of grade 1 or 2 in 23 patients (70%) and grade 3 in 2 patients (6%). Neurologic toxic effects occurred in 14 patients (42%) and were of grade 1 or 2 in 13 patients (39%). One patient (3%) had a reversible grade 4 neurologic toxic effect. The objective response rate was 85%, including 15 patients (45%) with complete responses. Six of the 15 patients who had a complete response have had a relapse. The median progression-free survival was 11.8 months (95% confidence interval, 6.2 to 17.8). All 16 patients who had a response (partial response or better) and who could be evaluated for minimal residual disease (MRD) had MRD-negative status (≤10-4 nucleated cells). CAR T-cell expansion was associated with responses, and CAR T cells persisted up to 1 year after the infusion. CONCLUSIONS We report the initial toxicity profile of a BCMA-directed cellular immunotherapy for patients with relapsed or refractory multiple myeloma. Antitumor activity was documented. (Funded by Bluebird Bio and Celgene; CRB-401 ClinicalTrials.gov number, NCT02658929.).
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Affiliation(s)
- Noopur Raje
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Jesus Berdeja
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Yi Lin
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - David Siegel
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Sundar Jagannath
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Deepu Madduri
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Michaela Liedtke
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Jacalyn Rosenblatt
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Marcela V Maus
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Ashley Turka
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Lyh-Ping Lam
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Richard A Morgan
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Kevin Friedman
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Monica Massaro
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Julie Wang
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Greg Russotti
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Zhihong Yang
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Timothy Campbell
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Kristen Hege
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Fabio Petrocca
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - M Travis Quigley
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - Nikhil Munshi
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
| | - James N Kochenderfer
- From the Massachusetts General Hospital Cancer Center (N.R., M.V.M.), Beth Israel Deaconess Medical Center (J.R.), and Dana-Farber Cancer Institute and Veterans Affairs Boston Healthcare System (N.M.), Boston, and Bluebird Bio, Cambridge (A.T., L.-P.L., R.A.M., K.F., M.M., F.P., M.T.Q.) - all in Massachusetts; Sarah Cannon Research Institute and Tennessee Oncology, Nashville (J.B.); Mayo Clinic, Rochester, MN (Y.L.); Hackensack University Medical Center, Hackensack (D.S.), and Celgene, Summit (J.W., G.R., Z.Y.) - both in New Jersey; Mount Sinai Medical Center, New York (S.J., D.M.); Stanford University Medical Center, Palo Alto (M.L.), and Celgene, San Francisco (T.C., K.H.) - both in California; and the Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (J.N.K.)
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3408
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Introduction by the Guest Editor, Terry J. Fry. Cancer J 2019; 25:178. [DOI: 10.1097/ppo.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3409
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3410
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Abstract
CAR T cells have revolutionized the treatment of relapsed and refractory CD19-positive leukemia and lymphoma. Unfortunately, the majority of patients treated will not achieve durable remissions. Reasons for these suboptimal clinical outcomes can be tied back to intrinsic CAR T cell design and manufacturing processes, factors that are highly amenable to modification and improvement. As CAR T cell therapy is being deployed in spaces outside of CD19-positive disease, these limitations, complications, and setbacks need to be overcome, allowing for the full potential of this novel therapy to be realized. Preclinical work has begun tackling these major roadblocks, paving the way for potentially off-the-shelf products that are safer and more potent. In time, a number of these advances will be translated to the clinic and usher in an era of CARs of the future.
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Affiliation(s)
- Anthony F. Daniyan
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renier J. Brentjens
- Cellular Therapeutics Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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3411
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Hirayama AV, Turtle CJ. Toxicities of CD19 CAR-T cell immunotherapy. Am J Hematol 2019; 94:S42-S49. [PMID: 30784102 DOI: 10.1002/ajh.25445] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022]
Abstract
CD19-targeted chimeric antigen receptor (CAR)-modified T (CAR-T) cell immunotherapy has demonstrated impressive results in B-cell malignancies, and CAR-T cell therapies targeting other antigens are in development for other cancers. Cytokine release syndrome (CRS) and neurotoxicity can be life-threatening in a subset of patients. The severity of CRS and neurotoxicity can be impacted by the disease burden, lymphodepletion regimen, and CAR-T cell dose. Tocilizumab and corticosteroids have been used to manage these toxicities, enabling CD19 CAR-T cells to be administered without obvious compromise in efficacy. Consensus criteria for grading and managing toxicities will facilitate the widespread application of this treatment modality.
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Affiliation(s)
- Alexandre V. Hirayama
- Clinical Research Division and Integrated Immunotherapy Research CenterFred Hutchinson Cancer Research Center Seattle Washington
| | - Cameron J. Turtle
- Clinical Research Division and Integrated Immunotherapy Research CenterFred Hutchinson Cancer Research Center Seattle Washington
- Department of MedicineUniversity of Washington Seattle Washington
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3412
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Liu Y, Barta SK. Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment. Am J Hematol 2019; 94:604-616. [PMID: 30859597 DOI: 10.1002/ajh.25460] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma originating from the germinal center, and it represents a heterogeneous group of diseases with variable outcomes that are differentially characterized by clinical features, cell of origin (COO), molecular features, and most recently, frequently recurring mutations. DIAGNOSIS DLBCL is ideally diagnosed from an excisional biopsy of a suspicious lymph node, which shows sheets of large cells that disrupt the underlying structural integrity of the follicle center and stain positive for pan-B-cell antigens, such as CD20 and CD79a. COO is determined by immunohistochemical stains, while molecular features such as double-hit or triple-hit disease are determined by fluorescent in situ hybridization analysis. Commercial tests for frequently recurring mutations are currently not routinely used to inform treatment. RISK STRATIFICATION Clinical prognostic systems for DLBCL, including the rituximab International Prognostic Index, age-adjusted IPI, and NCCN-IPI, use clinical factors for the risk stratification of patients, although this does not affect the treatment approach. Furthermore, DLBCL patients with non-germinal center B-cell (GCB)-like DLBCL (activated B-cell like and unclassifiable) have a poorer response to up-front chemoimmunotherapy (CI) compared to patients with GCB-like DLBCL. Those with c-MYC-altered disease alone and in combination with translocations in BCL2 and/or BCL6 (particularly when the MYC translocation partner is immunoglobulin) respond poorly to up-front CI and salvage autologous stem cell transplant at relapse. RISK-ADAPTED THERAPY This review will focus on differential treatment of DLBCL up-front and at the time of relapse by COO and molecular features.
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Affiliation(s)
- Yang Liu
- Fox Chase Cancer Center, Department of Hematology and Oncology Philadelphia Pennsylvania
| | - Stefan Klaus Barta
- Perelman Center for Advanced Medicine, University of Pennsylvania, Division Philadelphia Pennsylvania
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3413
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Feins S, Kong W, Williams EF, Milone MC, Fraietta JA. An introduction to chimeric antigen receptor (CAR) T-cell immunotherapy for human cancer. Am J Hematol 2019; 94:S3-S9. [PMID: 30680780 DOI: 10.1002/ajh.25418] [Citation(s) in RCA: 301] [Impact Index Per Article: 60.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy represents a major advancement in personalized cancer treatment. In this strategy, a patient's own T cells are genetically engineered to express a synthetic receptor that binds a tumor antigen. CAR T cells are then expanded for clinical use and infused back into the patient's body to attack and destroy chemotherapy-resistant cancer. Dramatic clinical responses and high rates of complete remission have been observed in the setting of CAR T-cell therapy of B-cell malignancies. This resulted in two recent FDA approvals of CAR T cells directed against the CD19 protein for treatment of acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Thus, CAR T cells are arguably one of the first successful examples of synthetic biology and personalized cellular cancer therapy to become commercially available. In this review, we introduce the concept of using CAR T cells to break immunological tolerance to tumors, highlight several challenges in the field, discuss the utility of biomarkers in the context of predicting clinical responses, and offer prospects for developing next-generation CAR T cell-based approaches that will improve outcome.
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Affiliation(s)
- Steven Feins
- Department of MicrobiologyPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Center for Cellular ImmunotherapiesUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Weimin Kong
- Department of MicrobiologyPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Center for Cellular ImmunotherapiesUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Erik F. Williams
- Department of MicrobiologyPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Center for Cellular ImmunotherapiesUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Michael C. Milone
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Center for Cellular ImmunotherapiesUniversity of Pennsylvania Philadelphia Pennsylvania
- Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
- Parker Institute for Cancer ImmunotherapyUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Joseph A. Fraietta
- Department of MicrobiologyPerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Department of Pathology and Laboratory MedicinePerelman School of Medicine, University of Pennsylvania Philadelphia Pennsylvania
- Center for Cellular ImmunotherapiesUniversity of Pennsylvania Philadelphia Pennsylvania
- Abramson Cancer CenterUniversity of Pennsylvania Philadelphia Pennsylvania
- Parker Institute for Cancer ImmunotherapyUniversity of Pennsylvania Philadelphia Pennsylvania
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3414
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McDermott K, Spendley L. Anti-CD19 CAR T-Cell Therapy for Adult Patients With Refractory Large B-Cell Lymphoma. J Adv Pract Oncol 2019; 10:11-20. [PMID: 33520342 PMCID: PMC7521124 DOI: 10.6004/jadpro.2019.10.4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapies represent a new paradigm in targeted cancer therapy. T cells play a key role in immune surveillance, but tumors have developed multiple mechanisms for evading that surveillance. CAR T-cell technology aims to enhance the innate ability of the body to fight foreign invaders, and in this way, effectively fight cancer and potentially reduce the number of treatments required. In fact, many patients have had long-lasting clinical responses to therapy with a single treatment. The journey to receiving CAR T-cell therapy involves a number of steps prior to infusion, including an initial consultation and workup, apheresis, bridging therapy, and lymphodepletion. Patients are then closely monitored after infusion. Successful treatment requires collaboration between the patient, caregivers, and the multidisciplinary team. Here we discuss the biology of CAR T-cell technology, clinical trial data, and the path to accessing this revolutionary and potentially curative treatment.
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Affiliation(s)
- Kathleen McDermott
- Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Lauren Spendley
- Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts
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3415
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Finney OC, Brakke H, Rawlings-Rhea S, Hicks R, Doolittle D, Lopez M, Futrell B, Orentas RJ, Li D, Gardner R, Jensen MC. CD19 CAR T cell product and disease attributes predict leukemia remission durability. J Clin Invest 2019; 129:2123-2132. [PMID: 30860496 PMCID: PMC6486329 DOI: 10.1172/jci125423] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T cells can induce remission in highly refractory leukemia and lymphoma subjects, yet the parameters for achieving sustained relapse-free survival are not fully delineated. METHODS We analyzed 43 pediatric and young adult subjects participating in a Phase I trial of defined composition CD19CAR T cells (NCT02028455). CAR T cell phenotype, function and expansion, as well as starting material T cell repertoire, were analyzed in relation to therapeutic outcome (defined as achieving complete remission within 63 days) and duration of leukemia free survival and B cell aplasia. RESULTS These analyses reveal that initial therapeutic failures (n = 5) were associated with attenuated CAR T cell expansion and/or rapid attrition of functional CAR effector cells following adoptive transfer. The CAR T products were similar in phenotype and function when compared to products resulting in sustained remissions. However, the initial apheresed peripheral blood T cells could be distinguished by an increased frequency of LAG-3+/TNF-αlow CD8 T cells and, following adoptive transfer, the rapid expression of exhaustion markers. For the 38 subjects who achieved an initial sustained MRD-neg remission, remission durability correlated with therapeutic products having increased frequencies of TNF-α-secreting CAR CD8+ T cells, and was dependent on a sufficiently high CD19+ antigen load at time of infusion to trigger CAR T cell proliferation. CONCLUSION These parameters have the potential to prospectively identify patients at risk for therapeutic failure and support the development of approaches to boost CAR T cell activation and proliferation in patients with low levels of CD19 antigen. TRIAL REGISTRATION ClinicalTrials.gov NCT02028455. FUNDING Partial funding for this study was provided by Stand Up to Cancer & St. Baldrick's Pediatric Dream Team Translational Research Grant (SU2C-AACR-DT1113), RO1 CA136551-05, Alex Lemonade Stand Phase I/II Infrastructure Grant, Conquer Cancer Foundation Career Development Award, Washington State Life Sciences Discovery Fund, Ben Towne Foundation, William Lawrence & Blanche Hughes Foundation, and Juno Therapeutics, Inc., a Celgene Company.
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Affiliation(s)
- Olivia C. Finney
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Hannah Brakke
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Stephanie Rawlings-Rhea
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Roxana Hicks
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Danielle Doolittle
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Marisa Lopez
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ben Futrell
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Rimas J. Orentas
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Daniel Li
- Clinical Statistics Group, Juno Therapeutics, Inc., Seattle, Washington, USA
| | - Rebecca Gardner
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Michael C. Jensen
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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3416
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Levin A, Shah NN. Chimeric antigen receptor modified T cell therapy in B cell non-Hodgkin lymphomas. Am J Hematol 2019; 94:S18-S23. [PMID: 30652353 DOI: 10.1002/ajh.25403] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 01/26/2023]
Abstract
Chimeric antigen receptor modified T (CAR-T) cell therapy against the CD19 antigen has revolutionized the therapeutic landscape for patients with relapsed, refractory B cell non-Hodgkin lymphoma (NHL). Currently, there are two FDA approved products (axicabtagene ciloleucel and tisagenlecleucel) for B cell NHL, with several other constructs under clinical investigation. This review will focus on the clinical outcomes, toxicity profile, and differences among candidate CD19 CAR-T cell products for major subtypes of B cell NHL including diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. Lastly, we will describe novel CAR-T constructs currently under exploration in B cell NHL.
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Affiliation(s)
- Adam Levin
- Division of Hematology & OncologyMedical College of Wisconsin Milwaukee Wisconsin
| | - Nirav N. Shah
- Division of Hematology & OncologyMedical College of Wisconsin Milwaukee Wisconsin
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3417
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Recent landmark studies in follicular lymphoma. Blood Rev 2019; 35:68-80. [DOI: 10.1016/j.blre.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
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3418
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Leung WH, Gay J, Martin U, Garrett TE, Horton HM, Certo MT, Blazar BR, Morgan RA, Gregory PD, Jarjour J, Astrakhan A. Sensitive and adaptable pharmacological control of CAR T cells through extracellular receptor dimerization. JCI Insight 2019; 5:124430. [PMID: 31039141 DOI: 10.1172/jci.insight.124430] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cell therapies have achieved promising outcomes in several cancers, however more challenging oncology indications may necessitate advanced antigen receptor designs and functions. Here we describe a bipartite receptor system comprised of separate antigen targeting and signal transduction polypeptides, each containing an extracellular dimerization domain. We demonstrate that T cell activation remains antigen dependent but can only be achieved in the presence of a dimerizing drug, rapamycin. Studies performed in vitro and in xenograft mouse models illustrate equivalent to superior anti-tumor potency compared to currently used CAR designs, and at rapamycin concentrations well below immunosuppressive levels. We further show that the extracellular positioning of the dimerization domains enables the administration of recombinant re-targeting modules, potentially extending antigen targeting. Overall, this novel regulatable CAR design has exquisite drug sensitivity, provides robust anti-tumor responses, and is uniquely flexible for multiplex antigen targeting or retargeting, which may further assist the development of safe, potent and durable T cell therapeutics.
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Affiliation(s)
| | - Joel Gay
- bluebird bio, inc., Cambridge, Massachusetts, USA
| | - Unja Martin
- bluebird bio, inc., Cambridge, Massachusetts, USA
| | | | | | | | - Bruce R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
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3419
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Abstract
Chimeric antigen receptor (CAR) T cells have been shown to successfully treat some hematopoietic malignancies. Recognition of a relevant target on malignant cells and the proper costimulatory molecule are essential for CAR T cell efficacy. In this issue of the JCI, Cohen et al. conducted an early phase trial to evaluate B cell maturation antigen-targeting (BCMA-targeting) CAR T cells in patients with refractory multiple myeloma. Patients who received the highest dose of BCMA-targeting CAR T cells in combination with lymphodepletion had the greatest response. The results of the study provide further support for the use of BCMA-targeting CAR T cells for myeloma, and reiterate the importance of space and cell dose for CAR T cell success.
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3420
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3421
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Osipov A, Murphy A, Zheng L. From immune checkpoints to vaccines: The past, present and future of cancer immunotherapy. Adv Cancer Res 2019; 143:63-144. [PMID: 31202363 DOI: 10.1016/bs.acr.2019.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cancer is a worldwide medical problem with significant repercussions on individual patients and societies as a whole. In order to alter the outcomes of this deadly disease the treatment of cancer over the centuries has undergone a unique evolution. However, utilizing the best treatment modalities and achieving cures or long-term durable responses have been inconsistent and limited, that is until recently. Contemporary research has highlighted a fundamental gap in our understanding of how we approach treating cancer, by revealing the intricate relationship between the immune system and tumors. In this atmosphere, the growth of immunotherapy has not only forever changed our understanding of cancer biology, but the manner by which we treat patients. It's paradigm shifting success has led to the approval of over 10 different immunotherapeutic agents, including checkpoint inhibitors, vaccine-based therapies, oncolytic viruses and T cell directed therapies for nearly 20 different indications across countless tumor types. Despite the breakthroughs that have occurred in the field of immunotherapy, it has not been the panacea for all cancers. With a deeper understanding of the immune system we have been able to peer into tumor immune escape and therapy resistance. Simultaneously this understanding has paved the way for the investigation and development of novel immune system altering agents and combinatorial therapies. In this chapter we review the immune system and its intricate relationship with cancer, the evolution of immunotherapy, its current landscape, and future directions in the context of resistance mechanisms and the challenges faced by immunotherapy against cancer.
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Affiliation(s)
- Arsen Osipov
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Adrian Murphy
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lei Zheng
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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3422
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Abstract
Genetically engineered T cells are powerful new medicines, offering hope for curative responses in patients with cancer. Chimeric antigen receptor (CAR) T cells were recently approved by the US Food and Drug Administration and are poised to enter the practice of medicine for leukemia and lymphoma, demonstrating that engineered immune cells can serve as a powerful new class of cancer therapeutics. The emergence of synthetic biology approaches for cellular engineering provides a broadly expanded set of tools for programming immune cells for enhanced function. Advances in T cell engineering, genetic editing, the selection of optimal lymphocytes, and cell manufacturing have the potential to broaden T cell-based therapies and foster new applications beyond oncology, in infectious diseases, organ transplantation, and autoimmunity.
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Affiliation(s)
- Sonia Guedan
- Department of Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
| | - Marco Ruella
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Parker Institute for Cellular Immunotherapy at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Carl H June
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
- Department of Medicine, Division of Hematology and Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Parker Institute for Cellular Immunotherapy at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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3423
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Hardiansyah D, Ng CM. Quantitative Systems Pharmacology Model of Chimeric Antigen Receptor T-Cell Therapy. Clin Transl Sci 2019; 12:343-349. [PMID: 30990958 PMCID: PMC6662387 DOI: 10.1111/cts.12636] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/11/2019] [Indexed: 01/22/2023] Open
Abstract
Chimeric antigen receptor T‐cell (CART) therapy is a new and promising cancer therapy. However, severe toxicity due to cytokine release syndrome (CRS) in CART‐treated patients highlighted the possible danger of this new therapy. Disease burden and CART doses are the potential factors associated with CRS but the detail relationships between these factors and the severity of the CRS remain largely unknown. In this study, the quantitative systems pharmacology (QSP) approach is used to quantify the complex relationships among CART doses, disease burden, and pro inflammatory cytokines in human subjects and to gain relevant insights into the determinant of clinical toxicity/efficacy in development of CART therapy. The expansion of CART and elimination of B cells are more highly correlated with disease burden than the administered CART doses. To our best knowledge, this is the first QSP model that can describe the observed clinical data from CART‐treated patients with cancer. This QSP model is a valuable tool for deepening our understanding of how the mechanism of action connects to the clinical outcomes and, therefore, may serve as an important model‐based platform to guide the development and personalized dosing of the CART therapy.
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Affiliation(s)
- Deni Hardiansyah
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Chee Meng Ng
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
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3424
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Recommendations for the management of hemophagocytic lymphohistiocytosis in adults. Blood 2019; 133:2465-2477. [PMID: 30992265 DOI: 10.1182/blood.2018894618] [Citation(s) in RCA: 549] [Impact Index Per Article: 109.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by aberrantly activated macrophages and cytotoxic T cells. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity and immune regulation, is most common in children, whereas the secondary (acquired) form is most frequent in adults. Secondary HLH is commonly triggered by infections or malignancies but may also be induced by autoinflammatory/autoimmune disorders, in which case it is called macrophage activation syndrome (MAS; or MAS-HLH). Most information on the diagnosis and treatment of HLH comes from the pediatric literature. Although helpful in some adult cases, this raises several challenges. For example, the HLH-2004 diagnostic criteria developed for children are commonly applied but are not validated for adults. Another challenge in HLH diagnosis is that patients may present with a phenotype indistinguishable from sepsis or multiple organ dysfunction syndrome. Treatment algorithms targeting hyperinflammation are frequently based on pediatric protocols, such as HLH-94 and HLH-2004, which may result in overtreatment and unnecessary toxicity in adults. Therefore, dose reductions, individualized tailoring of treatment duration, and an age-dependent modified diagnostic approach are to be considered. Here, we present expert opinions derived from an interdisciplinary working group on adult HLH, sponsored by the Histiocyte Society, to facilitate knowledge transfer between physicians caring for pediatric and adult patients with HLH, with the aim to improve the outcome for adult patients affected by HLH.
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3425
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Scarfò I, Frigault MJ, Maus MV. CAR-Based Approaches to Cutaneous T-Cell Lymphoma. Front Oncol 2019; 9:259. [PMID: 31058076 PMCID: PMC6477509 DOI: 10.3389/fonc.2019.00259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/11/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCL) are a heterogeneous group of malignancies characterized by the expansion of a malignant T cell clone. Chimeric Antigen Receptor (CAR) T cell therapy has shown impressive results for the treatment of B-cell tumors, but several challenges have prevented this approach in the context of T cell lymphoma. These challenges include the possibilities of fratricide due to shared T-cell antigens, T cell immunodeficiency, and CAR transduction of malignant cells if CAR T are manufactured in the autologous setting. In this review, we discuss these and other challenges in detail and summarize the approaches currently in development to overcome these challenges and offer cellular targeting of T cell lymphomas.
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Affiliation(s)
- Irene Scarfò
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Matthew J Frigault
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Marcela V Maus
- Cellular Immunotherapy Program, Massachusetts General Hospital Cancer Center, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Broad Institute of Harvard and MIT, Cambridge, MA, United States
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3426
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Chavez JC, Bachmeier C, Kharfan-Dabaja MA. CAR T-cell therapy for B-cell lymphomas: clinical trial results of available products. Ther Adv Hematol 2019; 10:2040620719841581. [PMID: 31019670 PMCID: PMC6466472 DOI: 10.1177/2040620719841581] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/07/2019] [Indexed: 12/17/2022] Open
Abstract
Adoptive cellular immunotherapy with chimeric antigen receptor (CAR) T cell has changed the treatment landscape of B-cell non-Hodgkin's lymphoma (NHL), especially for aggressive B-cell lymphomas. Single-center and multicenter clinical trials with anti-CD19 CAR T-cell therapy have shown great activity and long-term remissions in poor-risk diffuse large B-cell lymphoma (DLBCL) when no other effective treatment options are available. Two CAR T-cell products [axicabtagene ciloleucel (axi-cel) and tisagenlecleucel] have obtained US Food and Drug Administration approval for the treatment of refractory DLBCL after two lines of therapy. A third product, liso-cel, is currently being evaluated in clinical trials and preliminary results appear very promising. CAR T-cell-related toxicity with cytokine-release syndrome and neurotoxicity remain important potential complications of this therapy. Here, we review the s biology, structure, clinical trial results and toxicity of two commercially approved CAR T-cell products and others currently being studied in multicenter clinical trials in B-cell NHLs.
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Affiliation(s)
- Julio C Chavez
- Department of Malignant Hematology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Christina Bachmeier
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
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3427
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Busato D, Mossenta M, Baboci L, Di Cintio F, Toffoli G, Dal Bo M. Novel immunotherapeutic approaches for hepatocellular carcinoma treatment. Expert Rev Clin Pharmacol 2019; 12:453-470. [PMID: 30907177 DOI: 10.1080/17512433.2019.1598859] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The introduction of immune checkpoint inhibitors has been lately proposed for the treatment of hepatocellular carcinoma (HCC) with respect to other cancer types. Several immunotherapeutic approaches are now under evaluation for HCC treatment including: i) antibodies acting as immune checkpoint inhibitors; ii) antibodies targeting specific tumor-associated antigens; iii) chimeric antigen receptor redirected T (CAR-T) cells targeting specific tumor-associated antigens; iv) vaccination strategies with tumor-specific epitopes. Areas covered: The review provides a wide description of the clinical trials investigating the efficacy of the main immunotherapeutic approaches proposed for the treatment of patients affected by HCC. Expert opinion: The balancing between immunostimulative and immunosuppressive factors in the context of HCC tumor microenvironment results in heterogeneous response rates to immunotherapeutic approaches such as checkpoint inhibitors, among HCC patients. In this context, it becomes crucial the identification of predictive factors determining the treatment response. A multiple approach using different biomarkers could be useful to identify the subgroup of HCC patients responsive to the treatment with a checkpoint inhibitor (as an example, nivolumab) as single agent, and to identify those patients in which other treatment regimens, such as the combination with sorafenib, or with locoregional therapies, could be more effective.
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Affiliation(s)
- Davide Busato
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy.,b Department of Life Sciences , University of Trieste , Trieste , Italy
| | - Monica Mossenta
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy.,b Department of Life Sciences , University of Trieste , Trieste , Italy
| | - Lorena Baboci
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy
| | - Federica Di Cintio
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy.,b Department of Life Sciences , University of Trieste , Trieste , Italy
| | - Giuseppe Toffoli
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy
| | - Michele Dal Bo
- a Experimental and Clinical Pharmacology Unit , Centro di Riferimento Oncologico di Aviano (CRO), IRCCS , Aviano (PN) , Italy
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3428
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Telomerase-Targeted Cancer Immunotherapy. Int J Mol Sci 2019; 20:ijms20081823. [PMID: 31013796 PMCID: PMC6515163 DOI: 10.3390/ijms20081823] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 01/03/2023] Open
Abstract
Telomerase, an enzyme responsible for the synthesis of telomeres, is activated in many cancer cells and is involved in the maintenance of telomeres. The activity of telomerase allows cancer cells to replicate and proliferate in an uncontrolled manner, to infiltrate tissue, and to metastasize to distant organs. Studies to date have examined the mechanisms involved in the survival of cancer cells as targets for cancer therapeutics. These efforts led to the development of telomerase inhibitors as anticancer drugs, drugs targeting telomere DNA, viral vectors carrying a promoter for human telomerase reverse transcriptase (hTERT) genome, and immunotherapy targeting hTERT. Among these novel therapeutics, this review focuses on immunotherapy targeting hTERT and discusses the current evidence and future perspectives.
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3429
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Aujla A, Aujla R, Liu D. Inotuzumab ozogamicin in clinical development for acute lymphoblastic leukemia and non-Hodgkin lymphoma. Biomark Res 2019; 7:9. [PMID: 31011424 PMCID: PMC6458768 DOI: 10.1186/s40364-019-0160-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/27/2019] [Indexed: 12/26/2022] Open
Abstract
B cell acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL) frequently express CD19, CD20 and CD22 on the cell surfaces. Immunotherapeutic agents including antibodies and chimeric antigen receptor T cells are widely studied in clinical trials. Several antibody-drug conjugates (ADC) have been approved for clinical use (gemtuzumab ozogamicin in acute myeloid leukemia and brentuximab vedotin in Hodgkin lymphoma as well as CD30+ anaplastic large cell lymphoma). Inotuzumab ozogamicin (INO), a CD22 antibody conjugated with calicheamicin is one of the newest ADCs. INO has been approved for treatment of relapsed /refractory B cell precursor ALL. Multiple ongoing trials are evaluating its role in the relapsed /refractory B cell NHL. This review summarized recent development in INO applications for ALL and NHL.
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Affiliation(s)
- Amandeep Aujla
- 1Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595 USA
| | - Ravijot Aujla
- 2Punjab Institute of Medical Sciences, Jalandhar, Punjab 144006 India
| | - Delong Liu
- 1Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595 USA.,3Department of Oncology, The First affiliated hospital of Zhengzhou University, Zhengzhou, China
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3430
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Shimizu Y, Suzuki T, Yoshikawa T, Endo I, Nakatsura T. Next-Generation Cancer Immunotherapy Targeting Glypican-3. Front Oncol 2019; 9:248. [PMID: 31024850 PMCID: PMC6469401 DOI: 10.3389/fonc.2019.00248] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 12/16/2022] Open
Abstract
Glypican-3 (GPC3), a 65 kD protein consisting of 580 amino acids, is a heparan sulfate proteoglycan bound to the cell membrane by glycosylphosphatidylinositol. This protein is expressed in the liver and the kidney of healthy fetuses but is hardly expressed in adults, except in the placenta. Contrarily, GPC3 is specifically expressed in hepatocellular carcinoma (HCC), ovarian clear cell carcinoma, melanoma, squamous cell carcinoma of the lung, hepatoblastoma, nephroblastoma (Wilms tumor), yolk sac tumor, and some pediatric cancers. Although the precise function of GPC3 remains unclear, it has been strongly suggested that it is related to the malignant transformation of HCC. We identified GPC3 as a promising target for cancer immunotherapy and have been working on the development of cancer immunotherapeutic agents targeting it through clinical trials. In some trials, it was revealed that the GPC3 peptide vaccines we developed using human leukocyte antigen-A24- and A2-restricted GPC3-derived peptides could induce GPC3-specific cytotoxic T cells in most vaccinated patients and thereby improve their prognosis. To further improve the clinical efficacy of cancer immunotherapy targeting GPC3, we are also developing next-generation therapeutic strategies using T cells engineered to express antigen-specific T-cell receptor or chimeric antigen receptor. In addition, we have successfully monitored the levels of serum full-length GPC3 protein, which is somehow secreted in the blood. The utility of GPC3 as a biomarker for predicting tumor recurrence and treatment efficacy is now being considered. In this review article, we summarize the results of clinical trials carried out by our team and describe the novel agent targeting the cancer-specific shared antigen, GPC3.
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Affiliation(s)
- Yasuhiro Shimizu
- Division of Cancer Immunotherapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan.,Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Toshihiro Suzuki
- Division of Cancer Immunotherapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Toshiaki Yoshikawa
- Division of Cancer Immunotherapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsuya Nakatsura
- Division of Cancer Immunotherapy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
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3431
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Mochel JP, Ekker SC, Johannes CM, Jergens AE, Allenspach K, Bourgois-Mochel A, Knouse M, Benzekry S, Wierson W, LeBlanc AK, Kenderian SS. CAR T Cell Immunotherapy in Human and Veterinary Oncology: Changing the Odds Against Hematological Malignancies. AAPS JOURNAL 2019; 21:50. [PMID: 30963322 DOI: 10.1208/s12248-019-0322-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/17/2019] [Indexed: 01/14/2023]
Abstract
The advent of the genome editing era brings forth the promise of adoptive cell transfer using engineered chimeric antigen receptor (CAR) T cells for targeted cancer therapy. CAR T cell immunotherapy is probably one of the most encouraging developments for the treatment of hematological malignancies. In 2017, two CAR T cell therapies were approved by the US Food and Drug Administration: one for the treatment of pediatric acute lymphoblastic leukemia (ALL) and the other for adult patients with advanced lymphomas. However, despite significant progress in the area, CAR T cell therapy is still in its early days and faces significant challenges, including the complexity and costs associated with the technology. B cell lymphoma is the most common hematopoietic cancer in dogs, with an incidence approaching 0.1% and a total of 20-100 cases per 100,000 individuals. It is a widely accepted naturally occurring model for human non-Hodgkin's lymphoma. Current treatment is with combination chemotherapy protocols, which prolong life for less than a year in canines and are associated with severe dose-limiting side effects, such as gastrointestinal and bone marrow toxicity. To date, one canine study generated CAR T cells by transfection of mRNA for CAR domain expression. While this was shown to provide a transient anti-tumor activity, results were modest, indicating that stable, genomic integration of CAR modules is required in order to achieve lasting therapeutic benefit. This commentary summarizes the current state of knowledge on CAR T cell immunotherapy in human medicine and its potential applications in animal health, while discussing the potential of the canine model as a translational system for immuno-oncology research.
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Affiliation(s)
- Jonathan P Mochel
- Department of Biomedical Sciences, Iowa State University, Ames, Iowa, 50011, USA. .,Iowa State University College of Vet. Medicine, 2448 Lloyd, 1809 S Riverside Dr., Ames, Iowa, 50011-1250, USA.
| | - Stephen C Ekker
- Mayo Clinic Cancer Center Department of Biochemistry and Molecular Biology, Rochester, Minnesota, 55905, USA
| | - Chad M Johannes
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, 50011, USA
| | - Albert E Jergens
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, 50011, USA
| | - Karin Allenspach
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, 50011, USA
| | - Agnes Bourgois-Mochel
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, 50011, USA
| | - Michael Knouse
- Department of Biomedical Sciences, Iowa State University, Ames, Iowa, 50011, USA
| | - Sebastien Benzekry
- Team MONC, Institut National de Recherche en Informatique et en Automatique, Bordeaux, France
| | - Wesley Wierson
- Department of Genetics, Development, and Cell Biology, Iowa State University, Ames, Iowa, 50011, USA
| | - Amy K LeBlanc
- Comparative Oncology Program, Center for Cancer Research National Cancer Institute, Bethesda, Maryland, 20892, USA
| | - Saad S Kenderian
- Department of Medicine, Mayo Clinic Division of Hematology, Rochester, Minnesota, 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, 55905, USA
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3432
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Sommer C, Boldajipour B, Kuo TC, Bentley T, Sutton J, Chen A, Geng T, Dong H, Galetto R, Valton J, Pertel T, Juillerat A, Gariboldi A, Pascua E, Brown C, Chin SM, Sai T, Ni Y, Duchateau P, Smith J, Rajpal A, Van Blarcom T, Chaparro-Riggers J, Sasu BJ. Preclinical Evaluation of Allogeneic CAR T Cells Targeting BCMA for the Treatment of Multiple Myeloma. Mol Ther 2019; 27:1126-1138. [PMID: 31005597 DOI: 10.1016/j.ymthe.2019.04.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
Clinical success of autologous CD19-directed chimeric antigen receptor T cells (CAR Ts) in acute lymphoblastic leukemia and non-Hodgkin lymphoma suggests that CAR Ts may be a promising therapy for hematological malignancies, including multiple myeloma. However, autologous CAR T therapies have limitations that may impact clinical use, including lengthy vein-to-vein time and manufacturing constraints. Allogeneic CAR T (AlloCAR T) therapies may overcome these innate limitations of autologous CAR T therapies. Unlike autologous cell therapies, AlloCAR T therapies employ healthy donor T cells that are isolated in a manufacturing facility, engineered to express CARs with specificity for a tumor-associated antigen, and modified using gene-editing technology to limit T cell receptor (TCR)-mediated immune responses. Here, transcription activator-like effector nuclease (TALEN) gene editing of B cell maturation antigen (BCMA) CAR Ts was used to confer lymphodepletion resistance and reduced graft-versus-host disease (GvHD) potential. The safety profile of allogeneic BCMA CAR Ts was further enhanced by incorporating a CD20 mimotope-based intra-CAR off switch enabling effective CAR T elimination in the presence of rituximab. Allogeneic BCMA CAR Ts induced sustained antitumor responses in mice supplemented with human cytokines, and, most importantly, maintained their phenotype and potency after scale-up manufacturing. This novel off-the-shelf allogeneic BCMA CAR T product is a promising candidate for clinical evaluation.
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Affiliation(s)
- Cesar Sommer
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA.
| | - Bijan Boldajipour
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Tracy C Kuo
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Trevor Bentley
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Janette Sutton
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Amy Chen
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Tao Geng
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Holly Dong
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Roman Galetto
- Cellectis SA, 8 rue de la Croix Jarry, 75013 Paris, France
| | - Julien Valton
- Cellectis, Inc., 430 East 29th Street, New York, NY 10016, USA
| | - Thomas Pertel
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA
| | | | | | - Edward Pascua
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Colleen Brown
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Sherman M Chin
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Tao Sai
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Yajin Ni
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA
| | | | - Julianne Smith
- Cellectis, Inc., 430 East 29th Street, New York, NY 10016, USA
| | - Arvind Rajpal
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Thomas Van Blarcom
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Javier Chaparro-Riggers
- Pfizer Cancer Immunology Discovery, Pfizer Worldwide Research and Development, 230 E. Grand Avenue, South San Francisco, CA 94080, USA
| | - Barbra J Sasu
- Allogene Therapeutics, Inc., 210 E. Grand Avenue, South San Francisco, CA 94080, USA.
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3433
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Optimization of manufacturing conditions for chimeric antigen receptor T cells to favor cells with a central memory phenotype. Cytotherapy 2019; 21:593-602. [PMID: 30975603 DOI: 10.1016/j.jcyt.2019.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/14/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chimeric antigen receptor (CAR)-T cells are genetically engineered to recognize tumor-associated antigens and have potent cytolytic activity against tumors. Adoptive therapy with CAR-T cells has been highly successful in B-cell leukemia and lymphoma. However, in solid tumor settings, CAR-T cells face a particularly hostile tumor microenvironment where multiple immune suppressive factors serve to thwart the anti-cancer immune response. Clinical trials of solid tumor antigen-targeted CAR-T cells have shown limited efficacy, and issues for current CAR-T cell therapies include failures of expansion and persistence, tumor entry, deletion and functional exhaustion. METHODS We compared our standard protocol for CAR-T cell manufacturing, currently used to generate CAR-T cells for a phase 1 clinical trial, with two alternative approaches for T-cell activation and expansion. The resulting cultures were analyzed using multicolor flow cytometry, cytokine bead array and xCELLigence cytotoxicity assays. RESULTS We have found that by changing the method of activation we can promote generation of CAR-T cells with enhanced CD62L and CCR7 expression, increased interleukin (IL)-2 production and retention of cytolytic activity, albeit with slower kinetics. DISCUSSION We propose that these phenotypic characteristics are consistent with a central memory phenotype that will better enable CAR-T cell survival and persistence after activation in vivo, and we aim to test this in a continuation of our current phase 1 clinical trial of CAR-T cells in patients with advanced melanoma.
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3434
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Aljoundi AK, Agoni C, Olotu FA, Soliman MES. Turning to Computer-aided Drug Design in the Treatment of Diffuse Large B-cell Lymphoma: Has it been Helpful? Anticancer Agents Med Chem 2019; 19:1325-1339. [PMID: 30950356 DOI: 10.2174/1871520619666190405111526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Amidst the numerous effective therapeutic options available for the treatment of Diffuse Large B-cell Lymphoma (DLBCL), about 30-40% of patients treated with first-line chemoimmunotherapy still experience a relapse or refractory DLBCL. This has necessitated a continuous search for new therapeutic agents to augment the existing therapeutic arsenal. METHODS The dawn of Computer-Aided Drug Design (CADD) in the drug discovery process has accounted for persistency in the application of computational approaches either alone or in combinatorial strategies with experimental methods towards the identification of potential hit compounds with high therapeutic efficacy in abrogating DLBCL. RESULTS This review showcases the interventions of structure-based and ligand-based computational approaches which have led to the identification of numerous small molecule inhibitors against implicated targets in DLBCL therapy, even though many of these potential inhibitors are piled-up awaiting further experimental validation and exploration. CONCLUSION We conclude that a successful and a conscious amalgamation of CADD and experimental approaches could pave the way for the discovery of the next generation potential leads in DLBCL therapy with improved activities and minimal toxicities.
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Affiliation(s)
- Aimen K Aljoundi
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Clement Agoni
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Fisayo A Olotu
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Mahmoud E S Soliman
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
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3435
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Sánchez-Escamilla M, Yáñez San Segundo L, Urbano-Ispizua Á, Perales MÁ. CAR T cells: The future is already present. Med Clin (Barc) 2019; 152:281-286. [PMID: 30392694 PMCID: PMC8129896 DOI: 10.1016/j.medcli.2018.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Miriam Sánchez-Escamilla
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Nueva York (NY), Estados Unidos; Departamento de Enfermedades Hematológicas y Transplante de Médula Ósea, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España.
| | - Lucrecia Yáñez San Segundo
- Departamento de Enfermedades Hematológicas y Transplante de Médula Ósea, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, España; Departamento de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Álvaro Urbano-Ispizua
- Departamento de Hematología, Hospital Clinic, Universidad de Barcelona; Institut d'investigacions Biomèdiques August Pi i Sunyer e Instituto de Investigación Josep Carreras, Barcelona, España
| | - Miguel-Ángel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, Nueva York (NY), Estados Unidos; Weill Cornell Medical College, Nueva York (NY), Estados Unidos.
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3436
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Duarte RF, Labopin M, Bader P, Basak GW, Bonini C, Chabannon C, Corbacioglu S, Dreger P, Dufour C, Gennery AR, Kuball J, Lankester AC, Lanza F, Montoto S, Nagler A, Peffault de Latour R, Snowden JA, Styczynski J, Yakoub-Agha I, Kröger N, Mohty M. Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019. Bone Marrow Transplant 2019; 54:1525-1552. [PMID: 30953028 DOI: 10.1038/s41409-019-0516-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
This is the seventh special EBMT report on the indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. Our aim is to provide general guidance on transplant indications according to prevailing clinical practice in EBMT countries and centres. In order to inform patient decisions, these recommendations must be considered together with the risk of the disease, the risk of the transplant procedure and the results of non-transplant strategies. In over two decades since the first report, the EBMT indications manuscripts have incorporated changes in transplant practice coming from scientific and technical developments in the field. In this same period, the establishment of JACIE accreditation has promoted high quality and led to improved outcomes of patient and donor care and laboratory performance in transplantation and cellular therapy. An updated report with operating definitions, revised indications and an additional set of data with overall survival at 1 year and non-relapse mortality at day 100 after transplant in the commonest standard-of-care indications is presented. Additional efforts are currently underway to enable EBMT member centres to benchmark their risk-adapted outcomes as part of the Registry upgrade Project 2020 against national and/or international outcome data.
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Affiliation(s)
- Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda - Universidad Autónoma de Madrid, Madrid, Spain.
| | - Myriam Labopin
- EBMT Paris Study Office, Hopital Saint Antoine, Paris, France
| | - Peter Bader
- Goethe University Hospital, Frankfurt/Main, Germany
| | | | - Chiara Bonini
- Vita-Salute San Raffaele University & Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Christian Chabannon
- Institut Paoli Calmettes & Centre d'Investigations Cliniques en Biothérapies, Marseille, France
| | | | - Peter Dreger
- Medizinische Klinik V, Universität Heidelberg, Heidelberg, Germany
| | - Carlo Dufour
- Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | - Jürgen Kuball
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arjan C Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Arnon Nagler
- Chaim Sheva Medical Center, Tel-Hashomer, Israel
| | | | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jan Styczynski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Mohamad Mohty
- Hopital Saint Antoine, Sorbonne Université, Paris, France
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3437
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Abstract
PURPOSE OF REVIEW Diffuse large B cell lymphoma (DLBCL) is characterized by clinical heterogeneity that is not fully accounted for by pathologic features. Furthermore, real-time treatment modifications and detection of relapse are typically guided by radiographic imaging modalities which are imperfect. Here, we review the potential utility of minimal residual disease (MRD) assessment for informing treatment decisions and detecting relapse. RECENT FINDINGS The most promising method of MRD detection is based on analysis of circulating tumor DNA in the peripheral blood of patients with DLBCL. This approach can predict outcomes and response to treatment as well as detect relapse prior to clinical signs of recurrent disease. While some studies of MRD in DLBCL have been in the prospective setting, the ability of this technology to alter clinical outcomes is currently unknown. MRD detection provides a non-invasive way to gather information about DLBCL at various time points throughout the disease course. Its role is evolving and should be incorporated into prospective studies in order to demonstrate an impact on patient outcomes.
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3438
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Salas-Mckee J, Kong W, Gladney WL, Jadlowsky JK, Plesa G, Davis MM, Fraietta JA. CRISPR/Cas9-based genome editing in the era of CAR T cell immunotherapy. Hum Vaccin Immunother 2019; 15:1126-1132. [PMID: 30735463 DOI: 10.1080/21645515.2019.1571893] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The advent of engineered T cells as a form of immunotherapy marks the beginning of a new era in medicine, providing a transformative way to combat complex diseases such as cancer. Following FDA approval of CAR T cells directed against the CD19 protein for the treatment of acute lymphoblastic leukemia and diffuse large B cell lymphoma, CAR T cells are poised to enter mainstream oncology. Despite this success, a number of patients are unable to receive this therapy due to inadequate T cell numbers or rapid disease progression. Furthermore, lack of response to CAR T cell treatment is due in some cases to intrinsic autologous T cell defects and/or the inability of these cells to function optimally in a strongly immunosuppressive tumor microenvironment. We describe recent efforts to overcome these limitations using CRISPR/Cas9 technology, with the goal of enhancing potency and increasing the availability of CAR-based therapies. We further discuss issues related to the efficiency/scalability of CRISPR/Cas9-mediated genome editing in CAR T cells and safety considerations. By combining the tools of synthetic biology such as CARs and CRISPR/Cas9, we have an unprecedented opportunity to optimally program T cells and improve adoptive immunotherapy for most, if not all future patients.
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Affiliation(s)
- January Salas-Mckee
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Weimin Kong
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Whitney L Gladney
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Julie K Jadlowsky
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Gabriela Plesa
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Megan M Davis
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA.,b Department of Pathology and Laboratory Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Joseph A Fraietta
- a Center for Cellular Immunotherapies, Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA.,b Department of Pathology and Laboratory Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.,c Parker Institute for Cancer Immunotherapy , University of Pennsylvania , Philadelphia , PA , USA.,d Department of Microbiology, Perelman School of Medicine , University of Pennsylvania , Philadelphia, PA , USA
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3439
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Abid MB. Could the menagerie of the gut microbiome really cure cancer? Hope or hype. J Immunother Cancer 2019; 7:92. [PMID: 30940203 PMCID: PMC6444641 DOI: 10.1186/s40425-019-0561-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/11/2019] [Indexed: 12/20/2022] Open
Abstract
The investigational scale of the gut microbiome is expanding rapidly. In 2018, the intersection of gut microbiota and immuno-oncology received much attention. While the impact of gut microbiota on the immune system was already established, the year received an exponential expansion of microbiome’s role in the immunotherapy setting. The microbiome research pipeline is ripe for large-scale, prospective trials. Working knowledge of immune-based cancer treatments, heterogeneity in their responses and resistance mechanisms, relevant immunological and microbiological pathways and potential for gut microbiome in enhancing the responses, is critical.
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Affiliation(s)
- Muhammad Bilal Abid
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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3440
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Tanna JG, Ulrey R, Williams KM, Hanley PJ. Critical testing and parameters for consideration when manufacturing and evaluating tumor-associated antigen-specific T cells. Cytotherapy 2019; 21:278-288. [PMID: 30929992 DOI: 10.1016/j.jcyt.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022]
Abstract
The past year has seen remarkable translation of cellular and gene therapies, with U.S. Food and Drug Administration (FDA) approval of three chimeric antigen receptor (CAR) T-cell products, multiple gene therapy products, and the initiation of countless other pivotal clinical trials. What makes these new drugs most remarkable is their path to commercialization: they have unique requirements compared with traditional pharmaceutical drugs and require different potency assays, critical quality attributes and parameters, pharmacological and toxicological data, and in vivo efficacy testing. What's more, each biologic requires its own unique set of tests and parameters. Here we describe the unique tests associated with ex vivo-expanded tumor-associated antigen T cells (TAA-T). These tests include functional assays to determine potency, specificity, and identity; tests for pathogenic contaminants, such as bacteria and fungus as well as other contaminants such as Mycoplasma and endotoxin; tests for product characterization, tests to evaluate T-cell persistence and product efficacy; and finally, recommendations for critical quality attributes and parameters associated with the expansion of TAA-Ts.
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Affiliation(s)
- Jay G Tanna
- Program for Cell Enhancement and Technologies for Immunotherapy, Center for Cancer and Immunology Research
| | - Robert Ulrey
- Program for Cell Enhancement and Technologies for Immunotherapy, Center for Cancer and Immunology Research
| | - Kirsten M Williams
- Program for Cell Enhancement and Technologies for Immunotherapy, Center for Cancer and Immunology Research; Center for Cancer and Blood Disorders, and the Division of Blood and Marrow Transplantation; Children's National Health System and The George Washington University, Washington, DC, USA
| | - Patrick J Hanley
- Program for Cell Enhancement and Technologies for Immunotherapy, Center for Cancer and Immunology Research; Center for Cancer and Blood Disorders, and the Division of Blood and Marrow Transplantation; Children's National Health System and The George Washington University, Washington, DC, USA.
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3441
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Geyer MB, Rivière I, Sénéchal B, Wang X, Wang Y, Purdon TJ, Hsu M, Devlin SM, Palomba ML, Halton E, Bernal Y, van Leeuwen DG, Sadelain M, Park JH, Brentjens RJ. Safety and tolerability of conditioning chemotherapy followed by CD19-targeted CAR T cells for relapsed/refractory CLL. JCI Insight 2019; 5:122627. [PMID: 30938714 DOI: 10.1172/jci.insight.122627] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Subgroups of patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) exhibit suboptimal outcomes after standard therapies, including oral kinase inhibitors. We and others have previously reported on safety and efficacy of autologous CD19-targeted CAR T-cells for these patients; here we report safety and long-term follow-up of CAR T-cell therapy with or without conditioning chemotherapy for patients with R/R CLL and indolent B-cell non-Hodgkin lymphoma (B-NHL). METHODS We conducted a phase 1 clinical trial investigating CD19-targeted CAR T-cells incorporating a CD28 costimulatory domain (19-28z). Seventeen of 20 patients received conditioning chemotherapy prior to CAR T-cell infusion. Five patients with CLL received ibrutinib at the time of autologous T-cell collection and/or CAR T-cell administration. RESULTS This analysis included 16 patients with R/R CLL and 4 patients with R/R indolent B-NHL. Cytokine release syndrome (CRS) was observed in all 20 patients but grades 3 and 4 CRS and neurological events were uncommon (10% for each). Ex vivo expansion of T-cells and proportions of CD4+/CD8+ CAR T-cells with CD62L+CD127+ immunophenotype were significantly greater in patients on ibrutinib at leukapheresis. Three of 12 evaluable CLL patients receiving conditioning chemotherapy achieved CR (two had minimal residual disease-negative CR). All patients achieving CR remained progression-free at median follow-up of 53 months. CONCLUSION Conditioning chemotherapy and 19-28z CAR T-cells were acceptably tolerated across investigated dose levels in heavily pretreated patients with R/R CLL and indolent B-NHL, and a subgroup of patients achieved durable CR. Ibrutinib therapy may modulate autologous T-cell phenotype. TRIAL REGISTRATION ClinicalTrials.gov NCT00466531. FUNDING Juno Therapeutics.
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Affiliation(s)
- Mark B Geyer
- Department of Medicine.,Center for Cell Engineering
| | - Isabelle Rivière
- Center for Cell Engineering.,Michael G. Harris Cell Therapy and Cell Engineering Facility.,Molecular Pharmacology and Chemistry Program, and
| | - Brigitte Sénéchal
- Michael G. Harris Cell Therapy and Cell Engineering Facility.,Molecular Pharmacology and Chemistry Program, and
| | - Xiuyan Wang
- Center for Cell Engineering.,Michael G. Harris Cell Therapy and Cell Engineering Facility.,Molecular Pharmacology and Chemistry Program, and
| | - Yongzeng Wang
- Michael G. Harris Cell Therapy and Cell Engineering Facility
| | | | - Meier Hsu
- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sean M Devlin
- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | | | - Jae H Park
- Department of Medicine.,Center for Cell Engineering
| | - Renier J Brentjens
- Department of Medicine.,Center for Cell Engineering.,Molecular Pharmacology and Chemistry Program, and
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3442
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Ring A, Müller AMS. [Chemotherapy-Free Treatment of Hematological Neoplasias: Dream or Reality?]. PRAXIS 2019; 108:411-418. [PMID: 31039712 DOI: 10.1024/1661-8157/a003230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chemotherapy-Free Treatment of Hematological Neoplasias: Dream or Reality? Abstract. Hematologic neoplasias are a heterogeneous group of diseases based on clonal expansion of immature, dysfunctional blood cell populations. Chemotherapy can achieve long-term remission in some patients, but side effects are often severe and recurrences frequent. The fact that the immune system can have the strongest activity against tumor cells is well-known from the field of allogeneic stem cell transplantation. Accordingly, various immunological therapy approaches to combat malignant diseases have been pursued for a long time. New generations of antibody- and cell-based therapies lead to excellent remission rates; the combination of different technologies culminates today in the combination of the targeted specificity of antibody-like molecules with the efficiency of immune effector cells through the use of genetically modified T cells. Data on long-term remissions and long-term consequences still need to mature in order to finally evaluate efficacy and feasibility, especially of prolonged therapies.
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Affiliation(s)
- Alexander Ring
- 1 Zentrum für Hämatologie und Onkologie, Universitätsspital Zürich
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3443
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Nenu I, Breaban I, Pascalau S, Bora CN, Stefanescu H. The future is now: beyond first line systemic therapy in hepatocellular carcinoma. Transl Cancer Res 2019; 8:S261-S274. [PMID: 35117106 PMCID: PMC8797356 DOI: 10.21037/tcr.2018.11.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is becoming a worldwide concern due to its rising incidence. Although for the incipient stages there are curative therapies, the advanced disease represents a major provocation for the clinicians. 2008 marked as an important year for the hepatology community with the administration of sorafenib for late stages of HCC. Six years after this major discovery, the multikinase inhibitor still represents an important pillar, the first line treatment for the advanced liver cancer. Lenvatinib may represent a new promising first line strategy, but it is still unavailable in many countries. The last years represented an explosion in the research of HCC. Beyond the first line treatments there are a plethora of new emerging therapies. By far immunotherapy represents the major revolution in oncology. While adoptive immunotherapy is still at the beginning, immune check-point inhibitors bursted in many clinical trials with very encouraging results. This review summarises the major discoveries in the field of HCC with an emphasis on immunotherapy. It also briefly describes the important aspects of primary liver cancer immunology and the major ongoing clinical trials.
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Affiliation(s)
- Iuliana Nenu
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Breaban
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
| | - Sorana Pascalau
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina-Nelida Bora
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horia Stefanescu
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
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3444
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Abstract
Engineered immune-cell-based cancer therapies have demonstrated robust efficacy in B cell malignancies, but challenges such as the lack of ideal targetable tumour antigens, tumour-mediated immunosuppression and severe toxicity still hinder their therapeutic efficacy and broad applicability. Synthetic biology can be used to overcome these challenges and create more robust, effective adaptive therapies that enable the specific targeting of cancer cells while sparing healthy cells. In this Progress article, we review recently developed gene circuit therapies for cancer using immune cells, nucleic acids and bacteria as chassis. We conclude by discussing outstanding challenges and future directions for realizing these gene circuit therapies in the clinic.
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Affiliation(s)
- Ming-Ru Wu
- Synthetic Biology Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Barbara Jusiak
- Synthetic Biology Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Timothy K Lu
- Synthetic Biology Group, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Synthetic Biology Center, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Biophysics Program, Harvard University, Boston, MA, USA.
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA.
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3445
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Pal SK, Miller MJ, Agarwal N, Chang SM, Chavez-MacGregor M, Cohen E, Cole S, Dale W, Magid Diefenbach CS, Disis ML, Dreicer R, Graham DL, Henry NL, Jones J, Keedy V, Klepin HD, Markham MJ, Mittendorf EA, Rodriguez-Galindo C, Sabel MS, Schilsky RL, Sznol M, Tap WD, Westin SN, Johnson BE. Clinical Cancer Advances 2019: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2019; 37:834-849. [DOI: 10.1200/jco.18.02037] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | | | | | | | | | - Ezra Cohen
- University of California, San Diego, San Diego, CA
| | - Suzanne Cole
- Mercy Clinic Oncology and Hematology, Oklahoma City, OK
| | - William Dale
- City of Hope National Medical Center, Duarte, CA
| | | | | | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | | | | | - Joshua Jones
- University of Pennsylvania Health System, Philadelphia, PA
| | - Vicki Keedy
- Vanderbilt University Medical Center, Nashville, TN
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3446
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Chadha J, Hussein S, Zhan Y, Shulman J, Brody J, Ratner L, Steinberg A. Liposomal Vincristine as a Bridge Therapy Prior to CAR-T Therapy in Relapsed and Refractory Diffuse Large B-Cell Lymphoma? Int J Hematol Oncol Stem Cell Res 2019; 13:102-107. [PMID: 31372204 PMCID: PMC6660481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We report a case of a 76-year-old male with a history of relapsed and refractory diffuse large B-cell lymphoma (DLBCL).Our patient was initially treated with front line chemotherapy along with central nervous system (CNS) prophylaxis with complete response. He subsequently relapsed, was sensitive to second-line chemotherapy, and underwent autologous stem cell transplantation achieving a complete remission. Only a few months after transplant, the patient suffered his second relapse and was deemed a candidate for Chimeric Antigen Receptor T-Cell Therapy (CAR-T). Given his aggressive disease, combined with the time needed to generate CAR-T cells, a multidisciplinary team recommended to treat our patient with liposomal vincristine in combination with rituximab as a bridge therapy. Durable responses have been seen using liposomal vincristine based on results from a recent phase II trial in heavily pretreated patients with DLBCL1. This therapy was effective in stabilizing and reducing active disease in our patient. This case looks to illustrate the use of liposomal vincristine in combination with immunotherapy in a novel setting bridging highly selected patients with active and refractory lymphoma prior to CAR-T. Moreover, we expanded an additional therapeutic point, highlighting the importance of optimal disease control prior to CAR-T cell harvesting, as recent literature has shown that residual malignant cells in the pheresis product may be inadvertently be transfected with the CAR gene, resulting in resistance and further relapse2.
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Affiliation(s)
- Juskaran Chadha
- Department of Hematology & Medical Oncology, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | | | - Yougen Zhan
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Jonah Shulman
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Joshua Brody
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Lynn Ratner
- Department of Hematology & Medical Oncology, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | - Amir Steinberg
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
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3447
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Elicin O, Cihoric N, Vlaskou Badra E, Ozsahin M. Emerging patient-specific treatment modalities in head and neck cancer - a systematic review. Expert Opin Investig Drugs 2019; 28:365-376. [PMID: 30760055 DOI: 10.1080/13543784.2019.1582642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/11/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Head and neck cancer (HNC) is an immunosuppressive disease that demonstrates heterogeneous molecular characteristics and features of tumor-host interaction. Beside radiotherapy and surgery, the current standard of care in systemic treatment involves the use of cytotoxic chemotherapy, monoclonal antibodies (mAbs), and tyrosine kinase inhibitors (TKIs). There are also other modalities being developed under the category of immunotherapy, but they are overshadowed by the recent advancements of immune checkpoint inhibitors. AREAS COVERED This systematic review covers recent advancements in 'patient-specific' treatment modalities, which can be only administered to a given patient. EXPERT OPINION Currently, patient-specific treatment modalities in HNC mainly consist of active immunotherapy using adoptive cell therapies and/or gene engineered vectors. Despite the slow pace of development, the interest continues in these treatment modalities. The future of HNC treatment is expected to be guided by biomarkers and personalized approaches with tailored combinations of local treatments (radiotherapy, surgery), systemic agents and immune system modulation. Systematic research is required to generate robust data and obtain a high-level of evidence for the effectiveness of such treatment modalities.
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Affiliation(s)
- Olgun Elicin
- a Department of Radiation Oncology , Inselspital, Bern University Hospital and University of Bern , Bern , Switzerland
| | - Nikola Cihoric
- a Department of Radiation Oncology , Inselspital, Bern University Hospital and University of Bern , Bern , Switzerland
| | - Eugenia Vlaskou Badra
- a Department of Radiation Oncology , Inselspital, Bern University Hospital and University of Bern , Bern , Switzerland
| | - Mahmut Ozsahin
- b Department of Radiation Oncology , University of Lausanne, Centre Hospitalier Universitaire Vaudois (CHUV) , Lausanne , Switzerland
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3448
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Krichevsky AM, Uhlmann EJ. Oligonucleotide Therapeutics as a New Class of Drugs for Malignant Brain Tumors: Targeting mRNAs, Regulatory RNAs, Mutations, Combinations, and Beyond. Neurotherapeutics 2019; 16:319-347. [PMID: 30644073 PMCID: PMC6554258 DOI: 10.1007/s13311-018-00702-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Malignant brain tumors are rapidly progressive and often fatal owing to resistance to therapies and based on their complex biology, heterogeneity, and isolation from systemic circulation. Glioblastoma is the most common and most aggressive primary brain tumor, has high mortality, and affects both children and adults. Despite significant advances in understanding the pathology, multiple clinical trials employing various treatment strategies have failed. With much expanded knowledge of the GBM genome, epigenome, and transcriptome, the field of neuro-oncology is getting closer to achieve breakthrough-targeted molecular therapies. Current developments of oligonucleotide chemistries for CNS applications make this new class of drugs very attractive for targeting molecular pathways dysregulated in brain tumors and are anticipated to vastly expand the spectrum of currently targetable molecules. In this chapter, we will overview the molecular landscape of malignant gliomas and explore the most prominent molecular targets (mRNAs, miRNAs, lncRNAs, and genomic mutations) that provide opportunities for the development of oligonucleotide therapeutics for this class of neurologic diseases. Because malignant brain tumors focally disrupt the blood-brain barrier, this class of diseases might be also more susceptible to systemic treatments with oligonucleotides than other neurologic disorders and, thus, present an entry point for the oligonucleotide therapeutics to the CNS. Nevertheless, delivery of oligonucleotides remains a crucial part of the treatment strategy. Finally, synthetic gRNAs guiding CRISPR-Cas9 editing technologies have a tremendous potential to further expand the applications of oligonucleotide therapeutics and take them beyond RNA targeting.
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Affiliation(s)
- Anna M Krichevsky
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Initiative for RNA Medicine, Boston, Massachusetts, 02115, USA.
| | - Erik J Uhlmann
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Initiative for RNA Medicine, Boston, Massachusetts, 02115, USA
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Cazaux M, Grandjean CL, Lemaître F, Garcia Z, Beck RJ, Milo I, Postat J, Beltman JB, Cheadle EJ, Bousso P. Single-cell imaging of CAR T cell activity in vivo reveals extensive functional and anatomical heterogeneity. J Exp Med 2019; 216:1038-1049. [PMID: 30936262 PMCID: PMC6504219 DOI: 10.1084/jem.20182375] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/07/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022] Open
Abstract
Cazaux et al. use intravital imaging to dissect anti-CD19 CAR T cell activity. This study uncovers both anatomical and functional diversity in the outcome of anti-CD19 CAR T cell interactions with tumor cells impacting engraftment, killing dynamics, and tumor immunoediting. CAR T cells represent a potentially curative strategy for B cell malignancies. However, the outcome and dynamics of CAR T cell interactions in distinct anatomical sites are poorly understood. Using intravital imaging, we tracked interactions established by anti-CD19 CAR T cells in B cell lymphoma–bearing mice. Circulating targets trapped CAR T cells in the lungs, reducing their access to lymphoid organs. In the bone marrow, tumor apoptosis was largely due to CAR T cells that engaged, killed, and detached from their targets within 25 min. Notably, not all CAR T cell contacts elicited calcium signaling or killing while interacting with tumors, uncovering extensive functional heterogeneity. Mathematical modeling revealed that direct killing was sufficient for tumor regression. Finally, antigen-loss variants emerged in the bone marrow, but not in lymph nodes, where CAR T cell cytotoxic activity was reduced. Our results identify a previously unappreciated level of diversity in the outcomes of CAR T cell interactions in vivo, with important clinical implications.
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Affiliation(s)
- Marine Cazaux
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Cellule Pasteur, Paris, France
| | - Capucine L Grandjean
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France
| | - Fabrice Lemaître
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France
| | - Zacarias Garcia
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France
| | - Richard J Beck
- Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Idan Milo
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France
| | - Jérémy Postat
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, Cellule Pasteur, Paris, France
| | - Joost B Beltman
- Division of Drug Discovery and Safety, Leiden Academic Centre for Drug Research, Leiden University, Leiden, Netherlands
| | - Eleanor J Cheadle
- Targeted Therapy Group, Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Philippe Bousso
- Dynamics of Immune Responses Unit, Equipe Labellisée Ligue Contre le Cancer, Institut Pasteur, INSERM U1223, Paris, France
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Smith SD, Reddy P, Sokolova A, Chow VA, Lynch RC, Shadman MA, Till BG, Shustov AR, Warren EH, Ujjani CS, Menon MP, Tseng YD, Gopal AK. Eligibility for CAR T-cell therapy: An analysis of selection criteria and survival outcomes in chemorefractory DLBCL. Am J Hematol 2019; 94:E117-E116. [PMID: 30663774 DOI: 10.1002/ajh.25411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen D. Smith
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Prathima Reddy
- CHI Franciscan Health, Franciscan Inpatient Services Federal Way Washington, DC
| | - Alexandra Sokolova
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Victor A. Chow
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Ryan C. Lynch
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Mazyar A. Shadman
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Brian G. Till
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Andrei R. Shustov
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Edus H. Warren
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Chaitra S. Ujjani
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Manoj P. Menon
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Yolanda D. Tseng
- Department of Radiation Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
| | - Ajay K. Gopal
- Department of Medicine, Division of Medical Oncology, University of Washington Clinical Research Division Fred Hutchinson Cancer Research Center Seattle Washington, DC
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