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Li W, Wang X, Zhang X, Aziz AUR, Wang D. CAR-NK Cell Therapy: A Transformative Approach to Overcoming Oncological Challenges. Biomolecules 2024; 14:1035. [PMID: 39199421 PMCID: PMC11352442 DOI: 10.3390/biom14081035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/27/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
The use of chimeric antigen receptor (CAR) in natural killer (NK) cells for cancer therapy is gaining momentum, marking a significant shift in cancer treatment. This review aims to explore the potential of CAR-NK cell therapy in cancer immunotherapy, providing a fresh perspective. It discusses the innovative approaches in CAR-NK cell design and engineering, particularly targeting refractory or recurrent cancers. By comparing CAR-NK cells with traditional therapies, the review highlights their unique ability to tackle tumor heterogeneity and immune system suppression. Additionally, it explains how novel cytokines and receptors can enhance CAR-NK cell efficacy, specificity, and functionality. This review underscores the advantages of CAR-NK cells, including reduced toxicity, lower cost, and broader accessibility compared to CAR-T cells, along with their potential in treating both blood cancers and solid tumors.
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Affiliation(s)
- Wangshu Li
- China Key Laboratory for Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women, Dalian Women and Children’s Medical Group, Dalian 116012, China; (W.L.); (X.W.)
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xiuying Wang
- China Key Laboratory for Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women, Dalian Women and Children’s Medical Group, Dalian 116012, China; (W.L.); (X.W.)
| | - Xu Zhang
- The Second Affiliated Hospital of Harbin Medical University, Harbin 151801, China;
| | - Aziz ur Rehman Aziz
- China Key Laboratory for Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women, Dalian Women and Children’s Medical Group, Dalian 116012, China; (W.L.); (X.W.)
| | - Daqing Wang
- China Key Laboratory for Early Diagnosis and Biotherapy of Malignant Tumors in Children and Women, Dalian Women and Children’s Medical Group, Dalian 116012, China; (W.L.); (X.W.)
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2
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Wu J, Ghobadi A, Maziarz R, Patel K, Hsu H, Liu Z, Sheetz C, Kardel P, Fu C. Medicare Utilization and Cost Trends for CAR T Cell Therapies Across Settings of Care in the Treatment of Diffuse Large B-Cell Lymphoma. Adv Ther 2024; 41:3232-3246. [PMID: 38916811 PMCID: PMC11263250 DOI: 10.1007/s12325-024-02917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Chimeric antigen receptor T-cell (CAR T) therapies have transformed diffuse large B-cell lymphoma (DLBCL) treatment. It is important to better understand their use in Medicare Fee-for-Service (FFS) patients, who often differ from commercially insured populations in important ways. METHODS We analyzed Medicare FFS claims data, focusing on the utilization patterns across three CAR T products-lisocabtagene maraleucel (liso-cel), tisagenlecleucel (tisa-cel), and axicabtagene autoleucel (axi-cel)-which are indicated for the treatment of DLBCL. Our investigation covered the period from 2021 through 2022. This analysis spanned a 180-day period prior to CAR T procedure and extended to a 90-day post-CAR T. Utilization of healthcare services, healthcare spending, and comorbidities were assessed in the pre- and post-periods. Clinical trial and PPS-exempt center claims were removed from the analysis. Statistical comparisons between inpatient and outpatient cohorts were made using Wilcoxon's rank-sum tests for continuous variables and Chi-square tests or Fisher's exact tests for categorical variables. RESULTS Among the total 391 CAR T claims assessed, most of the CAR T therapies were administered in the inpatient setting (79%) compared to outpatient (21%). CAR T therapy in the inpatient setting received an average Medicare cost of US$498,723 ($276,138-$1,066,524), while the average Medicare cost for outpatient CAR T claims was $414,393 ($276,980-$849,878). There was a higher 3-month average post-period cost for those hospitals utilizing CAR T in the outpatient setting than the inpatient setting ($15,794 vs. $10,244). Despite the higher post-period cost, when looking at the CAR T procedure and pre- and post-periods as a single episode, beneficiaries receiving outpatient CAR T had less cost for the total episode of care ($587,908 vs. $529,188). Follow-up inpatient claims were also assessed post-CAR T procedure for 30 days. The rate of post-CAR T inpatient re-admission was significantly lower for beneficiaries receiving the index CAR T in the inpatient setting (21%) compared to outpatient CAR T (59%). Days between index CAR T discharge and IP admission were also significantly shorter for OP CAR T compared to IP CAR T (8.0 vs. 14.1 days, p < 0.0001). Additionally, IP CAR T had a longer ALOS on the admission claim (6.9 vs. 6.2 days). CONCLUSION CAR T therapy for the treatment of LBCL has become more common within the Medicare population, primarily in the inpatient setting. This study helps understand providers' cost and associated patient care around CAR T administration. The data show that the average cost received by hospitals encompasses the expenses related to both the CAR T drug and the medical services delivered to patients.
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Affiliation(s)
- James Wu
- Kite, A Gilead Company, Santa Monica, CA, USA
| | - Armin Ghobadi
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Hil Hsu
- Kite, A Gilead Company, Santa Monica, CA, USA
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3
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Chandra DJ, Alber B, Saultz JN. The Immune Resistance Signature of Acute Myeloid Leukemia and Current Immunotherapy Strategies. Cancers (Basel) 2024; 16:2615. [PMID: 39123343 PMCID: PMC11311077 DOI: 10.3390/cancers16152615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/29/2024] [Accepted: 07/11/2024] [Indexed: 08/12/2024] Open
Abstract
Acute myeloid leukemia (AML) is a complex hematopoietic clonal disorder with limited curative options beyond stem cell transplantation. The success of transplant is intimately linked with the graft versus leukemia effect from the alloreactive donor immune cells including, T and NK cells. The immune system plays a dynamic role in leukemia survival and resistance. Despite our growing understanding of the immune microenvironment, responses to immune-based therapies differ greatly between patients. Herein, we review the biology of immune evasion mechanisms in AML, discuss the current landscape of immunotherapeutic strategies, and discuss the implications of therapeutic targets. This review focuses on T and NK cell-based therapy, including modified and non-modified NK cells, CAR-T and CAR-NK cells, antibodies, and checkpoint blockades. Understanding the complex interchange between immune tolerance and the emergence of tumor resistance will improve patient outcomes.
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Affiliation(s)
- Daniel J. Chandra
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA;
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Bernhard Alber
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Jennifer N. Saultz
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, OR 97239, USA;
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA;
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4
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Coelho J, Roush SM, Xu AM, Puranam K, Mponda M, Kasonkanji E, Mulenga M, Tomoka T, Galeotti J, Brownlee A, Ghadially H, Damania B, Painschab M, Merchant A, Gopal S, Fedoriw Y. HIV and prior exposure to antiretroviral therapy alter tumour composition and tumour: T-cell associations in diffuse large B-cell lymphoma. Br J Haematol 2024; 205:194-206. [PMID: 38769021 PMCID: PMC11245366 DOI: 10.1111/bjh.19531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of lymphoma worldwide, accounting for up to 40% of new non-Hodgkin Lymphoma (NHL) globally. People living with HIV are up to 17 times more likely to develop NHL, and as such, DLBCL is the leading cause of cancer death in this high-risk population. While histologically indistinguishable, HIV-associated (HIV+) and HIV-negative (HIV-) DLBCL are molecularly distinct, and biological differences may have implications for the development of future therapeutic interventions. Further, the impact of immunologic differences in people with HIV, including preceding ART, remains largely unknown. Here, we investigate the impact of HIV infection and ART exposure on the clinical features of DLBCL and T-cell immune response by performing imaging mass cytometry on our unique patient cohort in Malawi. In this cohort, HIV infection is positively prognostic, and HIV+/ART-naïve patients have the best outcomes. No established biomarkers other than Ki67 are associated with HIV or ART status, and the only tumour-intrinsic biomarkers that remain prognostic are MYC and MYC/BCL2 protein co-expression. Finally, TCR clonality is associated with distinct tumour-T cell interactions by HIV/ART status, indicating differential anti-tumour immune responses. We demonstrate previously undescribed HIV and ART-related differences in the DLBCL tumour microenvironment.
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Affiliation(s)
- Jenny Coelho
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Sophia M. Roush
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Alexander M. Xu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Marriam Mponda
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Edwards Kasonkanji
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Maurice Mulenga
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Tamiwe Tomoka
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
| | - Jonathan Galeotti
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Amy Brownlee
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Hormas Ghadially
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Blossom Damania
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, School of Medicine, UNC, Chapel Hill, NC, USA
| | - Matthew Painschab
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Division of Hematology, Department of Medicine, UNC, Chapel Hill, NC
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Satish Gopal
- National Cancer Institute Center for Global Health, Rockville, MD, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina (UNC), Chapel Hill, NC, USA
- UNC Project Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Lilongwe, Malawi
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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5
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Gamal W, Mediavilla-Varela M, Uriepero-Palma A, Pinilla-Ibarz J, Sahakian E. Optimization of In Vitro Th17 Polarization for Adoptive Cell Therapy in Chronic Lymphocytic Leukemia. Int J Mol Sci 2024; 25:6324. [PMID: 38928031 PMCID: PMC11203624 DOI: 10.3390/ijms25126324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
Although preclinical investigations have shown notable efficacy in solid tumor models utilizing in vitro-differentiated Th17 cells for adoptive cell therapy (ACT), the potential benefits of this strategy in enhancing ACT efficacy in hematological malignancies, such as chronic lymphocytic leukemia (CLL), remain unexplored. CLL is a B-cell malignancy with a clinical challenge of increased resistance to targeted therapies. T-cell therapies, including chimeric antigen receptor (CAR) T cells, have demonstrated limited success in CLL, which is attributed to CLL-mediated T-cell dysfunction and skewing toward immunosuppressive phenotypes. Herein, we illustrate the feasibility of polarizing CD4+ T cells from the Eμ-TCL1 murine model, the most representative model for human CLL, into Th17 phenotype, employing a protocol of T-cell activation through the inducible co-stimulator (ICOS) alongside a polarizing cytokine mixture. We demonstrate augmented memory properties of in vitro-polarized IL-17-producing T cells, and preliminary in vivo persistence in leukemia-bearing mice. Our findings gain translational relevance through successful viral transduction of Eμ-TCL1 CD4+ T cells with a CD19-targeted CAR construct during in vitro Th17 polarization. Th17 CAR T cells exhibited remarkable persistence upon encountering antigen-expressing target cells. This study represents the first demonstration of the potential of in vitro-differentiated Th17 cells to enhance ACT efficacy in CLL.
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MESH Headings
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Animals
- Th17 Cells/immunology
- Mice
- Immunotherapy, Adoptive/methods
- Humans
- Lymphocyte Activation/immunology
- Receptors, Chimeric Antigen/immunology
- Receptors, Chimeric Antigen/metabolism
- Cell Differentiation
- Disease Models, Animal
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Affiliation(s)
- Wael Gamal
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | | | - Angimar Uriepero-Palma
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Javier Pinilla-Ibarz
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Eva Sahakian
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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6
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Morsy MM, Azzam AY, Elamin O, Elswedy A, Nashwan AJ. Safety and efficacy of chimeric antigen receptor T-cell therapy for acute myeloid leukemia: A subgroup based meta-analysis. Leuk Res 2024; 140:107498. [PMID: 38582045 DOI: 10.1016/j.leukres.2024.107498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Acute myeloid leukemia (AML) is a significant hematological malignancy in the United States, with a high mortality rate and limited treatment options. CAR T-cell therapy, a new and promising treatment, is being investigated for its efficacy and safety in AML. This meta-analysis aims to assess the safety and efficacy of CAR T-cell therapy in AML, considering various subgroups such as study location, study design, prior transplantation status, conditioning regimen, and CAR T-cell source. METHODS We conducted a comprehensive literature review across multiple databases, adhering to PRISMA guidelines and focusing on studies concerning CAR T-cell therapy in AML. We included original articles in English and excluded non-original reviews, abstracts, and non-English studies. The risk of bias was assessed using the Cochrane ROBINS-I tool. Statistical analysis involved meta-analysis with Cochrane's Q-test and I² statistic, using both fixed-effect and random-effects models, and assessed for publication bias. RESULTS Our search yielded studies encompassing 57 AML patients treated with CAR T-cell therapy. The meta-analysis revealed a 48% incidence of complete remission with CAR T-cell therapy, varying significantly across subgroups based on study design, location, prior transplantation, conditioning regimen, and CAR T-cell source. The highest complete remission rates were observed in patients from China, those who had undergone prior hematopoietic cell transplantation, and those treated with fludarabine and cyclophosphamide conditioning regimen. Adverse events included graft-versus-host disease (7%) and cytokine release syndrome (53%). CONCLUSIONS This meta-analysis highlights the potential of CAR T-cell therapy in AML treatment, especially when integrated with certain prior treatments and conditioning regimens. The findings suggest a higher efficacy in patients with previous hematopoietic cell transplantation and specific conditioning regimens. Further large-scale, randomized trials are essential to confirm these findings and establish CAR T-cell therapy as a standard treatment for AML.
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Affiliation(s)
| | - Ahmed Y Azzam
- Faculty of Medicine, October 6 University, Giza, Egypt
| | - Osman Elamin
- Department of Neurosurgery, Jordan Hospital, Amman, Jordan
| | - Adam Elswedy
- Faculty of Medicine, October 6 University, Giza, Egypt
| | - Abdulqadir J Nashwan
- Nursing & Midwifery Research Department (NMRD), Hamad Medical Corporation, Doha, Qatar.
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7
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Nichakawade TD, Ge J, Mog BJ, Lee BS, Pearlman AH, Hwang MS, DiNapoli SR, Wyhs N, Marcou N, Glavaris S, Konig MF, Gabelli SB, Watson E, Sterling C, Wagner-Johnston N, Rozati S, Swinnen L, Fuchs E, Pardoll DM, Gabrielson K, Papadopoulos N, Bettegowda C, Kinzler KW, Zhou S, Sur S, Vogelstein B, Paul S. TRBC1-targeting antibody-drug conjugates for the treatment of T cell cancers. Nature 2024; 628:416-423. [PMID: 38538786 PMCID: PMC11250631 DOI: 10.1038/s41586-024-07233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/16/2024] [Indexed: 04/06/2024]
Abstract
Antibody and chimeric antigen receptor (CAR) T cell-mediated targeted therapies have improved survival in patients with solid and haematologic malignancies1-9. Adults with T cell leukaemias and lymphomas, collectively called T cell cancers, have short survival10,11 and lack such targeted therapies. Thus, T cell cancers particularly warrant the development of CAR T cells and antibodies to improve patient outcomes. Preclinical studies showed that targeting T cell receptor β-chain constant region 1 (TRBC1) can kill cancerous T cells while preserving sufficient healthy T cells to maintain immunity12, making TRBC1 an attractive target to treat T cell cancers. However, the first-in-human clinical trial of anti-TRBC1 CAR T cells reported a low response rate and unexplained loss of anti-TRBC1 CAR T cells13,14. Here we demonstrate that CAR T cells are lost due to killing by the patient's normal T cells, reducing their efficacy. To circumvent this issue, we developed an antibody-drug conjugate that could kill TRBC1+ cancer cells in vitro and cure human T cell cancers in mouse models. The anti-TRBC1 antibody-drug conjugate may provide an optimal format for TRBC1 targeting and produce superior responses in patients with T cell cancers.
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Affiliation(s)
- Tushar D Nichakawade
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Jiaxin Ge
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Brian J Mog
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Bum Seok Lee
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Alexander H Pearlman
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Michael S Hwang
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Genentech, San Francisco, CA, USA
| | - Sarah R DiNapoli
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Nicolas Wyhs
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Nikita Marcou
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Stephanie Glavaris
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Maximilian F Konig
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra B Gabelli
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Discovery Chemistry, Merck Research Laboratory, Merck and Co, West Point, PA, USA
| | - Evangeline Watson
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Cole Sterling
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nina Wagner-Johnston
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sima Rozati
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lode Swinnen
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ephraim Fuchs
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Drew M Pardoll
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kathy Gabrielson
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nickolas Papadopoulos
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kenneth W Kinzler
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shibin Zhou
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Surojit Sur
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bert Vogelstein
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Bloomberg~Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Suman Paul
- Ludwig Center and Lustgarten Laboratory, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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8
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Trabolsi A, Arumov A, Schatz JH. Bispecific antibodies and CAR-T cells: dueling immunotherapies for large B-cell lymphomas. Blood Cancer J 2024; 14:27. [PMID: 38331870 PMCID: PMC10853226 DOI: 10.1038/s41408-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
Despite recent advances in frontline therapy for diffuse large B-cell lymphoma (DLBCL), at least a third of those diagnosed still will require second or further lines for relapsed or refractory (rel/ref) disease. A small minority of these can be cured with standard chemoimmunotherapy/stem-cell transplant salvage approaches. CD19-directed chimeric antigen receptor T-cell (CAR-19) therapies are increasingly altering the prognostic landscape for rel/ref patients with DLBCL and related aggressive B-cell non-Hodgkin lymphomas. Long-term follow up data show ongoing disease-free outcomes consistent with cure in 30-40% after CAR-19, including high-risk patients primary refractory to or relapsing within 1 year of frontline treatment. This has made CAR-19 a preferred option for these difficult-to-treat populations. Widespread adoption, however, remains challenged by logistical and patient-related hurdles, including a requirement for certified tertiary care centers concentrated in urban centers, production times of at least 3-4 weeks, and high per-patients costs similar to allogeneic bone-marrow transplantation. Bispecific antibodies (BsAbs) are molecular biotherapies designed to bind and activate effector T-cells and drive them to B-cell antigens, leading to a similar cellular-dependent cytotoxicity as CAR-19. May and June of 2023 saw initial approvals of next-generation BsAbs glofitamab and epcoritamab in DLBCL as third or higher-line therapy, or for patients ineligible for CAR-19. BsAbs have similar spectrum but generally reduced severity of immune related side effects as CAR-19 and can be administered in community settings without need to manufacture patient-specific cellular products. To date and in contrast to CAR-19, however, there is no convincing evidence of cure after BsAbs monotherapy, though follow up is limited. The role of BsAbs in DLBCL treatment is rapidly evolving with trials investigating use in both relapsed and frontline curative-intent combinations. The future of DLBCL treatment is bound increasingly to include effector cell mediated immunotherapies, but further optimization of both cellular and BsAb approaches is needed.
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Affiliation(s)
- Asaad Trabolsi
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA
- Hematology-Oncology Fellowship Program, Jackson Memorial Health System/ University of Miami, Miami, Fl, USA
| | - Artavazd Arumov
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, USA
| | - Jonathan H Schatz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Fl, USA.
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Fl, USA.
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9
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Cho JY, Jang SC, Kang DW, Lee EK, Koh H, Yoon DH, Park MH. A nationwide analysis of the treatment patterns, survival, and medical costs in Korean patients with relapsed or refractory diffuse large B-cell lymphoma. Front Oncol 2024; 14:1282323. [PMID: 38361777 PMCID: PMC10867264 DOI: 10.3389/fonc.2024.1282323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Approximately one-third of patients with diffuse large B-cell lymphoma (DLBCL) are refractory to treatment or experience relapse after initial therapy. Unfortunately, treatment options for older patients and those who experience relapse or become refractory to hematopoietic stem cell transplantation (HSCT) are limited. This nationwide population-based study aimed to identify treatment patterns, survival times, and treatment costs in patients with relapsed/refractory DLBCL (R/R DLBCL). Materials and methods Between 2011 and 2020, data on patients with R/R DLBCL were retrieved from the Korean Health Insurance Review & Assessment Service, encompassing the entire population. We identified the treatment patterns for each treatment line using a Sankey diagram and calculated the median time to the subsequent treatment in line. Median overall and progression-free survival times were estimated using the Kaplan-Meier survival curves. Finally, the medical costs incurred during DLBCL treatment were calculated for each treatment line and the costs related to HSCT were summarized at the episode level. Results A total of 864 patients with R/R DLBCL who received second-line treatment were identified, and a regimen of ifosfamide, carboplatin, and etoposide (ICE) was administered the most. Among them, 353 were refractory or relapsed cases that were treated with third-line treatments. The median times for second-line to third-line, third-line to fourth-line, fourth-line to fifth-line, and fifth-line to sixth-line treatment failures gradually decreased (3.93, 2.86, 1.81, and 1.38 months, respectively). The median overall survival time was 8.90 and 4.73 months following the second-line and third-line treatments, respectively. In the third-line treatment setting, the patients did not show a significant difference in survival time after HSCT. The median medical cost was $39,491 across all treatment lines including the cost of HSCT which was $22,054. Conclusion The treatment patterns in patients with R/R DLBCL, especially at third-line treatments and thereafter, were complicated, and their prognosis was poor despite the high medical costs. Novel and effective treatment options are expected to improve the prognosis and alleviate the economic burden of patients with R/R DLBCL.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | | | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
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10
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Ho M, Zanwar S, Paludo J. Chimeric antigen receptor T-cell therapy in hematologic malignancies: Successes, challenges, and opportunities. Eur J Haematol 2024; 112:197-210. [PMID: 37545132 DOI: 10.1111/ejh.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
The success of chimeric antigen receptor T-cell (CAR-T) therapy in hematologic malignancies has realized a longstanding effort toward harnessing the immune system to fight cancer in a truly personalized fashion. Second generation chimeric antigen receptors (CAR) incorporating co-stimulatory molecules like 4-1BB or CD28 were able to overcome some of the hindrances with initial CAR constructs resulting in efficacious products. Many second-generation CAR-T products have been approved in the treatment of relapsed/refractory hematologic malignancies including multiple myeloma (MM), non-Hodgkin lymphoma (NHL), and acute lymphoblastic leukemia. However, challenges remain in optimizing the manufacturing, timely access, limiting the toxicity from CAR-T infusions and improving sustainability of responses derived with CAR-T therapy. Here, we summarize the clinical trial data leading to approval CAR-T therapies in MM and NHL, discuss the limitations with current CAR-T therapy strategies and review emerging strategies for overcoming these limitations.
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Affiliation(s)
- Matthew Ho
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Saurabh Zanwar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonas Paludo
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Caracciolo D, Polerà N, Belmonte B, Conforti F, Signorelli S, Gulino A, Staropoli N, Tuccillo FM, Bonelli P, Juli G, Grillone K, Ascrizzi S, Cirillo M, Migale L, Ballerini A, Pelizon C, Di Martino MT, Tagliaferri P, Riillo C, Tassone P. UMG1/CD3ε-bispecific T-cell engager redirects T-cell cytotoxicity against diffuse large B-cell lymphoma. Br J Haematol 2024; 204:555-560. [PMID: 37963444 DOI: 10.1111/bjh.19183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
UMG1 is a unique epitope of CD43, not expressed by normal cells and tissues of haematopoietic and non-haematopoietic origin, except thymocytes and a minority (<5%) of peripheral blood T lymphocytes. By immunohistochemistry analysis of tissue microarray and pathology slides, we found high UMG1 expression in 20%-24% of diffuse large B-cell lymphomas (DLBCLs), including highly aggressive BCL2high and CD20low cases. UMG1 membrane expression was also found in DLBCL bone marrow-infiltrating cells and established cell lines. Targeting UMG1 with a novel asymmetric UMG1/CD3ε-bispecific T-cell engager (BTCE) induced redirected cytotoxicity against DLBCL cells and was synergistic with lenalidomide. We conclude that UMG1/CD3ε-BTCE is a promising therapeutic for DLBCLs.
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Affiliation(s)
- Daniele Caracciolo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Nicoletta Polerà
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, Palermo, Sicily, Italy
| | | | - Stefania Signorelli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Gulino
- Cogentech srl Società Benefit, FIRC Institute of Molecular Oncology (IFOM), Milan, Italy
| | - Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Franca Maria Tuccillo
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Napoli, Italy
| | - Patrizia Bonelli
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Napoli, Italy
| | - Giada Juli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Katia Grillone
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Serena Ascrizzi
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Maria Cirillo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Migale
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | | | | | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
- S.H.R.O., Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
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12
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Liu Y, Peng C, Ahad F, Ali Zaidi SA, Muluh TA, Fu Q. Advanced Strategies of CAR-T Cell Therapy in Solid Tumors and Hematological Malignancies. Recent Pat Anticancer Drug Discov 2024; 19:557-572. [PMID: 38213150 DOI: 10.2174/0115748928277331231218115402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 01/13/2024]
Abstract
Chimeric antigen receptor T-cells, known as CAR-T cells, represent a promising breakthrough in the realm of adoptive cell therapy. These T-cells are genetically engineered to carry chimeric antigen receptors that specifically target tumors. They have achieved notable success in the treatment of blood-related cancers, breathing new life into this field of medical research. However, numerous obstacles limit chimeric antigen receptors T-cell therapy's efficacy, such as it cannot survive in the body long. It is prone to fatigue and exhaustion, leading to difficult tumor elimination and repeated recurrence, affecting solid tumors and hematological malignancies. The challenges posed by solid tumors, especially in the context of the complex solid-tumor microenvironment, require specific strategies. This review outlines recent advancements in improving chimeric antigen receptors T-cell therapy by focusing on the chimeric antigen receptors protein, modifying T-cells, and optimizing the interaction between T-cells and other components within the tumor microenvironment. This article aims to provide an extensive summary of the latest discoveries regarding CAR-T cell therapy, encompassing its application across various types of human cancers. Moreover, it will delve into the obstacles that have emerged in recent times, offering insights into the challenges faced by this innovative approach. Finally, it highlights novel therapeutic options in treating hematological and solid malignancies with chimeric antigen receptors T-cell therapies.
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Affiliation(s)
- Yangjie Liu
- Department of Pharmacy, Luzhou People's Hospital, Luzhou 646000, Sichuan, PRC China
| | - Cao Peng
- Department of Pharmacy, Luzhou People's Hospital, Luzhou 646000, Sichuan PRC China
| | - Faiza Ahad
- Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China
| | - Syed Aqib Ali Zaidi
- Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China
| | - Tobias Achu Muluh
- Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China
| | - Qiuxia Fu
- Department of Pharmacy, Luzhou People's Hospital, Luzhou 646000, Sichuan PRC China
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13
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Testa U, Leone G, Pelosi E, Castelli G, Hohaus S. CAR-T Cell Therapy in Large B Cell Lymphoma. Mediterr J Hematol Infect Dis 2023; 15:e2023066. [PMID: 38028399 PMCID: PMC10631715 DOI: 10.4084/mjhid.2023.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Large B-cell lymphomas (LBCLs) are among the most frequent (about 30%) non-Hodgkin's lymphoma. Despite the aggressive behavior of these lymphomas, more than 60% of patients can be cured with first-line chemoimmunotherapy using the R-CHOP regimen. Patients with refractory or relapsing disease show a poor outcome even when treated with second-line therapies. CD19-targeted chimeric antigen receptor (CAR) T-cells are emerging as an efficacious second-line treatment strategy for patients with LBCL. Three CD19-CAR-T-cell products received FDA and EMA approval. CAR-T cell therapy has also been explored for treating high-risk LBCL patients in the first-line setting and for patients with central nervous system involvement. Although CD19-CAR-T therapy has transformed the care of refractory/relapsed LBCL, about 60% of these patients will ultimately progress or relapse following CD19-CAR-T; therefore, it is fundamental to identify predictive criteria of response to CAR-T therapy and to develop salvage therapies for patients relapsing after CD19-CAR-T therapies. Moreover, ongoing clinical trials evaluate bispecific CAR-T cells targeting both CD19 and CD20 or CD19 and CD22 as a tool to improve the therapeutic efficacy and reduce the number of refractory/relapsing patients.
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Affiliation(s)
| | - Giuseppe Leone
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
| | | | | | - Stefan Hohaus
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy. Sezione Di Ematologia
- Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
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14
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Prazeres PHDM, Ferreira H, Costa PAC, da Silva W, Alves MT, Padilla M, Thatte A, Santos AK, Lobo AO, Sabino A, Del Puerto HL, Mitchell MJ, Guimaraes PPG. Delivery of Plasmid DNA by Ionizable Lipid Nanoparticles to Induce CAR Expression in T Cells. Int J Nanomedicine 2023; 18:5891-5904. [PMID: 37873551 PMCID: PMC10590593 DOI: 10.2147/ijn.s424723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Chimeric antigen receptor (CAR) cell therapy represents a hallmark in cancer immunotherapy, with significant clinical results in the treatment of hematological tumors. However, current approved methods to engineer T cells to express CAR use viral vectors, which are integrative and have been associated with severe adverse effects due to constitutive expression of CAR. In this context, non-viral vectors such as ionizable lipid nanoparticles (LNPs) arise as an alternative to engineer CAR T cells with transient expression of CAR. Methods Here, we formulated a mini-library of LNPs to deliver pDNA to T cells by varying the molar ratios of excipient lipids in each formulation. LNPs were characterized and screened in vitro using a T cell line (Jurkat). The optimized formulation was used ex vivo to engineer T cells derived from human peripheral blood mononuclear cells (PBMCs) for the expression of an anti-CD19 CAR (CAR-CD19BBz). The effectiveness of these CAR T cells was assessed in vitro against Raji (CD19+) cells. Results LNPs formulated with different molar ratios of excipient lipids efficiently delivered pDNA to Jurkat cells with low cytotoxicity compared to conventional transfection methods, such as electroporation and lipofectamine. We show that CAR-CD19BBz expression in T cells was transient after transfection with LNPs. Jurkat cells transfected with our top-performing LNPs underwent activation when exposed to CD19+ target cells. Using our top-performing LNP-9-CAR, we were able to engineer human primary T cells to express CAR-CD19BBz, which elicited significant specific killing of CD19+ target cells in vitro. Conclusion Collectively, our results show that LNP-mediated delivery of pDNA is a suitable method to engineer human T cells to express CAR, which holds promise for improving the production methods and broader application of this therapy in the future.
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Affiliation(s)
- Pedro Henrique Dias Moura Prazeres
- Department of Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Heloísa Ferreira
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Walison da Silva
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marco Túllio Alves
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marshall Padilla
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ajay Thatte
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Anderson Kenedy Santos
- Department of Pediatrics/Gastroenterology and Hepatology, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
| | | | - Adriano Sabino
- Department of Clinical and Toxicological Analysis, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Helen Lima Del Puerto
- Department of Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Michael J Mitchell
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Pedro Pires Goulart Guimaraes
- Department of Pathology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
- Department of Physiology and Biophysics, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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15
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Chen HH, Kuo CY, Ho CL, Chen YC. Chylothorax after chimeric antigen receptor T cell therapy for relapsed and refractory diffuse large B-cell lymphoma: A case report. Medicine (Baltimore) 2023; 102:e35432. [PMID: 37832125 PMCID: PMC10578660 DOI: 10.1097/md.0000000000035432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 10/15/2023] Open
Abstract
RATIONALE Anti-CD19-targeted chimeric antigen receptor (CAR) T cell therapy is effective in treating relapsed/refractory diffuse large B-cell lymphoma (DLBCL). This therapy is associated with several side effects that can be life-threatening such as cytokine release syndrome (CRS). However, chylothorax associated with CRS after CAR-T therapy has not been reported. PATIENT CONCERNS A 23-year-old male diagnosed with DLBCL relapsing after autologous peripheral blood stem cell transplantation was treated with anti-CD19-targeted CAR-T cell therapy. After CAR-T cell transfusion, he developed grade 3 CRS includes fever, dyspnea, tachycardia and hypotension. The symptoms of CRS persisted and chest plain film revealed bilateral pleural effusion. DIAGNOSIS Chylothorax was confirmed by the pleural effusion analysis that triglyceride level was 1061 mg/dL. Bacterial and fungal culture of pleural fluid reported no pathogen was detected. Cytological examination of pleural effusion revealed no malignant cells. INTERVENTIONS The chylothorax resolved after treatment with intravenous administration of tocilizumab. OUTCOMES On 30-day follow-up, the patient was in stable clinical condition with complete remission of DLBCL on whole-body positron emission tomography scan. LESSONS We reported a rare case of CAR-T associated chylothorax in a patient with relapsed and refractory DLBCL. Grade 3 CRS with high interleukin-6 level was presented in our patient. The symptoms of CRS were improved with tocilizumab treatment and the chylothorax resolved later on. It is suggested that high interleukin-6 releases might induce chyle leakage resulting from activations of endothelium and coagulation. Our finding highlights the occurrence of chylothorax during the course of CAR-T cell therapy and the importance of proper monitoring and prompt management of this life-threatening side effect.
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Affiliation(s)
- Hsin-Hui Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Cheng-Yi Kuo
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei City, Taiwan
- UWELL Biopharma Inc., New Taipei City, Taiwan
| | - Ching-Liang Ho
- Division of Hematology & Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yeu-Chin Chen
- Division of Hematology & Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
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16
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Xu J, Luo W, Li C, Mei H. Targeting CD22 for B-cell hematologic malignancies. Exp Hematol Oncol 2023; 12:90. [PMID: 37821931 PMCID: PMC10566133 DOI: 10.1186/s40164-023-00454-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
CD19-targeted chimeric receptor antigen (CAR)-T cell therapy has shown remarkable clinical efficacy in the treatment of relapsed or refractory (R/R) B-cell malignancies. However, 30%-60% of patients eventually relapsed, with the CD19-negative relapse being an important hurdle to sustained remission. CD22 expression is independent of CD19 expression in malignant B cells. Consequently, CD22 is a potential alternative target for CD19 CAR-T cell-resistant patients. CD22-targeted therapies, mainly including the antibody-drug conjugates (ADCs) and CAR-T cells, have come into wide clinical use with acceptable toxicities and promising efficacy. In this review, we explore the molecular and physiological characteristics of CD22, development of CD22 ADCs and CAR-T cells, and the available clinical data on CD22 ADCs and CAR-T cell therapies. Furthermore, we propose some perspectives for overcoming tumor escape and enhancing the efficacy of CD22-targeted therapies.
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Affiliation(s)
- Jia Xu
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Wenjing Luo
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Chenggong Li
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
| | - Heng Mei
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
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17
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Martín García-Sancho A, Baile M, Rodríguez G, Dlouhy I, Sancho JM, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, Redondo A, Enjuanes A, Campo E, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from GELTAMO. Br J Haematol 2023; 203:202-211. [PMID: 37485564 DOI: 10.1111/bjh.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R-ESHAP (LR-ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1-14 of every 21-day cycle, in combination with R-ESHAP at standard doses. Responding patients underwent autologous stem-cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell-of-origin (COO) classification was performed. Forty-six patients were included. The ORR after LR-ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease (n = 26) had significantly worse ORR than patients with non-refractory disease (54% vs. 85%, p = 0.031). No differences in response rates according to the COO were observed. Twenty-eight patients (61%) underwent ASCT. At a median follow-up of 41 months, the estimated 3-year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment-related deaths during LR-ESHAP cycles. In conclusion, LR-ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.
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Affiliation(s)
- A Martín García-Sancho
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - M Baile
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - G Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío/Virgen Macarena, Sevilla, Spain
| | - I Dlouhy
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | - J M Sancho
- Hematology Department, Hospital Germans Trias i Pujol/ICO-IJC, Badalona, Spain
| | - I Jarque
- Hematology Department, Hospital Universitari i Plotècnic La Fe, CIBERONC, Valencia, Spain
| | - E González-Barca
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de-Barcelona, Barcelona, Spain
| | - A Salar
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - M Espeso
- Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - C Grande
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Bergua
- Hematology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - S Montes-Moreno
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Redondo
- Hematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - A Enjuanes
- Unidad de Genómica del IDIBAPS, Barcelona, Spain
| | - E Campo
- Pathology Department, Hospital Clinic, Barcelona, Spain
| | | | - D Caballero
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
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18
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Yang K, Halima A, Chan TA. Antigen presentation in cancer - mechanisms and clinical implications for immunotherapy. Nat Rev Clin Oncol 2023; 20:604-623. [PMID: 37328642 DOI: 10.1038/s41571-023-00789-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/18/2023]
Abstract
Over the past decade, the emergence of effective immunotherapies has revolutionized the clinical management of many types of cancers. However, long-term durable tumour control is only achieved in a fraction of patients who receive these therapies. Understanding the mechanisms underlying clinical response and resistance to treatment is therefore essential to expanding the level of clinical benefit obtained from immunotherapies. In this Review, we describe the molecular mechanisms of antigen processing and presentation in tumours and their clinical consequences. We examine how various aspects of the antigen-presentation machinery (APM) shape tumour immunity. In particular, we discuss genomic variants in HLA alleles and other APM components, highlighting their influence on the immunopeptidomes of both malignant cells and immune cells. Understanding the APM, how it is regulated and how it changes in tumour cells is crucial for determining which patients will respond to immunotherapy and why some patients develop resistance. We focus on recently discovered molecular and genomic alterations that drive the clinical outcomes of patients receiving immune-checkpoint inhibitors. An improved understanding of how these variables mediate tumour-immune interactions is expected to guide the more precise administration of immunotherapies and reveal potentially promising directions for the development of new immunotherapeutic approaches.
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Affiliation(s)
- Kailin Yang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy A Chan
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA.
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, OH, USA.
- National Center for Regenerative Medicine, Cleveland, OH, USA.
- Case Comprehensive Cancer Center, Cleveland, OH, USA.
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19
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Bücklein V, Perez A, Rejeski K, Iacoboni G, Jurinovic V, Holtick U, Penack O, Kharboutli S, Blumenberg V, Ackermann J, Frölich L, Johnson G, Patel K, Arciola B, Mhaskar R, Wood A, Schmidt C, Albanyan O, Gödel P, Hoster E, Bullinger L, Mackensen A, Locke F, von Bergwelt M, Barba P, Subklewe M, Jain MD. Inferior Outcomes of EU Versus US Patients Treated With CD19 CAR-T for Relapsed/Refractory Large B-cell Lymphoma: Association With Differences in Tumor Burden, Systemic Inflammation, Bridging Therapy Utilization, and CAR-T Product Use. Hemasphere 2023; 7:e907. [PMID: 37449196 PMCID: PMC10337711 DOI: 10.1097/hs9.0000000000000907] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/03/2023] [Indexed: 07/18/2023] Open
Abstract
Real-world evidence suggests a trend toward inferior survival of patients receiving CD19 chimeric antigen receptor (CAR) T-cell therapy in Europe (EU) and with tisagenlecleucel. The underlying logistic, patient- and disease-related reasons for these discrepancies remain poorly understood. In this multicenter retrospective observational study, we studied the patient-individual journey from CAR-T indication to infusion, baseline features, and survival outcomes in 374 patients treated with tisagenlecleucel (tisa-cel) or axicabtagene-ciloleucel (axi-cel) in EU and the United States (US). Compared with US patients, EU patients had prolonged indication-to-infusion intervals (66 versus 50 d; P < 0.001) and more commonly received intermediary therapies (holding and/or bridging therapy, 94% in EU versus 74% in US; P < 0.001). Baseline lactate dehydrogenase (LDH) (median 321 versus 271 U/L; P = 0.02) and ferritin levels (675 versus 425 ng/mL; P = 0.004) were significantly elevated in the EU cohort. Overall, we observed inferior survival in EU patients (median progression-free survival [PFS] 3.1 versus 9.2 months in US; P < 0.001) and with tisa-cel (3.2 versus 9.2 months with axi-cel; P < 0.001). On multivariate Lasso modeling, nonresponse to bridging, elevated ferritin, and increased C-reactive protein represented independent risks for treatment failure. Weighing these variables into a patient-individual risk balancer (high risk [HR] balancer), we found higher levels in EU versus US and tisa-cel versus axi-cel cohorts. Notably, superior PFS with axi-cel was exclusively evident in patients at low risk for progression (according to the HR balancer), but not in high-risk patients. These data demonstrate that inferior survival outcomes in EU patients are associated with longer time-to-infusion intervals, higher tumor burden/LDH levels, increased systemic inflammatory markers, and CAR-T product use.
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Affiliation(s)
- Veit Bücklein
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
| | - Ariel Perez
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
- Blood and Marrow Transplant Program, Miami Cancer Institute, Miami, FL, USA
| | - Kai Rejeski
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gloria Iacoboni
- Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, Department of Medicine, Universitat Autònoma of Barcelona (UAB), Spain
| | - Vindi Jurinovic
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital, Cologne, University of Cologne, Germany
| | - Olaf Penack
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Soraya Kharboutli
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Germany
| | - Viktoria Blumenberg
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Lisa Frölich
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Grace Johnson
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Kedar Patel
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Brian Arciola
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Rahul Mhaskar
- USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Anthony Wood
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Omar Albanyan
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Philipp Gödel
- Department I of Internal Medicine, Medical Faculty and University Hospital, Cologne, University of Cologne, Germany
| | - Eva Hoster
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Germany
| | - Lars Bullinger
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Germany
| | - Frederick Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael von Bergwelt
- Department of Medicine III, University Hospital, LMU Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pere Barba
- Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, Department of Medicine, Universitat Autònoma of Barcelona (UAB), Spain
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK) Munich Site, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
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20
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Meringa AD, Hernández-López P, Cleven A, de Witte M, Straetemans T, Kuball J, Beringer DX, Sebestyen Z. Strategies to improve γδTCRs engineered T-cell therapies for the treatment of solid malignancies. Front Immunol 2023; 14:1159337. [PMID: 37441064 PMCID: PMC10333927 DOI: 10.3389/fimmu.2023.1159337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- A. D. Meringa
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - P. Hernández-López
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - A. Cleven
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - M. de Witte
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - T. Straetemans
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - J. Kuball
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - D. X. Beringer
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Z. Sebestyen
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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21
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Gregucci F, Spada S, Barcellos-Hoff MH, Bhardwaj N, Chan Wah Hak C, Fiorentino A, Guha C, Guzman ML, Harrington K, Herrera FG, Honeychurch J, Hong T, Iturri L, Jaffee E, Karam SD, Knott SR, Koumenis C, Lyden D, Marciscano AE, Melcher A, Mondini M, Mondino A, Morris ZS, Pitroda S, Quezada SA, Santambrogio L, Shiao S, Stagg J, Telarovic I, Timmerman R, Vozenin MC, Weichselbaum R, Welsh J, Wilkins A, Xu C, Zappasodi R, Zou W, Bobard A, Demaria S, Galluzzi L, Deutsch E, Formenti SC. Updates on radiotherapy-immunotherapy combinations: Proceedings of 6 th annual ImmunoRad conference. Oncoimmunology 2023; 12:2222560. [PMID: 37363104 PMCID: PMC10286673 DOI: 10.1080/2162402x.2023.2222560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Focal radiation therapy (RT) has attracted considerable attention as a combinatorial partner for immunotherapy (IT), largely reflecting a well-defined, predictable safety profile and at least some potential for immunostimulation. However, only a few RT-IT combinations have been tested successfully in patients with cancer, highlighting the urgent need for an improved understanding of the interaction between RT and IT in both preclinical and clinical scenarios. Every year since 2016, ImmunoRad gathers experts working at the interface between RT and IT to provide a forum for education and discussion, with the ultimate goal of fostering progress in the field at both preclinical and clinical levels. Here, we summarize the key concepts and findings presented at the Sixth Annual ImmunoRad conference.
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Affiliation(s)
- Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Sheila Spada
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Mary Helen Barcellos-Hoff
- Department of Radiation Oncology, School of Medicine, University of California, San Francisco, CA, USA
| | - Nina Bhardwaj
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alba Fiorentino
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monica L. Guzman
- Division of Hematology/Oncology, Department of Medicine, Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Harrington
- The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, National Institute for Health Research Biomedical Research Centre, London, UK
| | - Fernanda G. Herrera
- Centre Hospitalier Universitaire Vaudois, University of Lausanne and Ludwig Institute for Cancer Research at the Agora Cancer Research Center, Lausanne, Switzerland
| | - Jamie Honeychurch
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Theodore Hong
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, INSERM U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Elisabeth Jaffee
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado, Aurora, CO, USA
| | - Simon R.V. Knott
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Lyden
- Children’s Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children’s Health, Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Alan Melcher
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Michele Mondini
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- Université of Paris-Saclay, Saclay, France
- INSERM U1030, Radiothérapie Moléculaire et Innovation Thérapeutique, Villejuif, France
| | - Anna Mondino
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zachary S. Morris
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sean Pitroda
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA
| | - Sergio A. Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Laura Santambrogio
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, New York, NY, USA
| | - Stephen Shiao
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Stagg
- Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Faculty of Pharmacy, Montreal, Canada
| | - Irma Telarovic
- Laboratory for Applied Radiobiology, Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Timmerman
- Departments of Radiation Oncology and Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marie-Catherine Vozenin
- Laboratory of Radiation Oncology, Radiation Oncology Service, Department of Oncology, CHUV, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, Ludwig Center for Metastases Research, University of Chicago, IL, USA
| | - James Welsh
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom, Royal Marsden Hospital, Sutton, UK
| | - Chris Xu
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY, USA
| | - Roberta Zappasodi
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Weiping Zou
- Departments of Surgery and Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Sandra Demaria
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, New York, NY, USA
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- Université of Paris-Saclay, Saclay, France
- INSERM U1030, Radiothérapie Moléculaire et Innovation Thérapeutique, Villejuif, France
| | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
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22
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Gamal W, Sahakian E, Pinilla-Ibarz J. The role of Th17 cells in chronic lymphocytic leukemia: friend or foe? Blood Adv 2023; 7:2401-2417. [PMID: 36574293 PMCID: PMC10238851 DOI: 10.1182/bloodadvances.2022008985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022] Open
Abstract
T helper 17 (Th17) cells have a prominent role in autoimmune diseases. In contrast, the nature of these cells in cancer is controversial, with either pro- or antitumorigenic activities depending on various cancer settings. Chronic lymphocytic leukemia (CLL), a B-cell malignancy, is characterized by an imbalance in T-cell immune responses that contributes to disease progression and increased mortality. Many clinical reports indicate an increase in Th17 cells and/or interleukin 17 serum cytokine levels in patients with CLL compared with healthy individuals, which correlates with various prognostic markers and significant changes in the tumor microenvironment. The exact mechanisms by which Th17 cells might contribute to CLL progression remain poorly investigated. In this review, we provide an updated presentation of the clinical information related to the significance of Th17 cells in CLL and their interaction with the complex leukemic microenvironment, including various mediators, immune cells, and nonimmune cells. We also address the available data regarding the effects of CLL-targeted therapies on Th17 cells and the potential of using these cells in adoptive cell therapies. Having a sound understanding of the role played by Th17 cells in CLL is crucial for designing novel therapies that can achieve immune homeostasis and maximize clinical benefits.
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Affiliation(s)
- Wael Gamal
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Eva Sahakian
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Javier Pinilla-Ibarz
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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23
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Urak R, Gittins B, Soemardy C, Grepo N, Goldberg L, Maker M, Shevchenko G, Davis A, Li S, Scott T, Morris KV, Forman SJ, Wang X. Evaluation of the Elements of Short Hairpin RNAs in Developing shRNA-Containing CAR T Cells. Cancers (Basel) 2023; 15:2848. [PMID: 37345185 DOI: 10.3390/cancers15102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Short hairpin RNAs (shRNAs) have emerged as a powerful tool for gene knockdown in various cellular systems, including chimeric antigen receptor (CAR) T cells. However, the elements of shRNAs that are crucial for their efficacy in developing shRNA-containing CAR T cells remain unclear. In this study, we evaluated the impact of different shRNA elements, including promoter strength, orientation, multiple shRNAs, self-targeting, and sense and antisense sequence composition on the knockdown efficiency of the target gene in CAR T cells. Our findings highlight the importance of considering multiple shRNAs and their orientation to achieve effective knockdown. Moreover, we demonstrate that using a strong promoter and avoiding self-targeting can enhance CAR T cell functionality. These results provide a framework for the rational design of CAR T cells with shRNA-mediated knockdown capabilities, which could improve the therapeutic efficacy of CAR T cell-based immunotherapy.
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Affiliation(s)
- Ryan Urak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Brenna Gittins
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Citradewi Soemardy
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Nicole Grepo
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Lior Goldberg
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Madeleine Maker
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Galina Shevchenko
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Alicia Davis
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Shirley Li
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Tristan Scott
- Center for Gene Therapy, Beckman Research Institute, Duarte, CA 91010, USA
| | - Kevin V Morris
- Menzies Health Institute Queensland, School of Pharmacy and Medical Science, Griffith University, Gold Coast Campus, Southport, QLD 4215, Australia
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Xiuli Wang
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
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24
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Awasthi R, Maier HJ, Zhang J, Lim S. Kymriah® (tisagenlecleucel) - An overview of the clinical development journey of the first approved CAR-T therapy. Hum Vaccin Immunother 2023:2210046. [PMID: 37185251 DOI: 10.1080/21645515.2023.2210046] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The emergence of cell and gene therapies has dramatically changed the treatment paradigm in oncology and other therapeutic areas. Kymriah® (tisagenlecleucel), a CD19-directed genetically modified autologous T-cell immunotherapy, is currently approved in major markets for the treatment of relapsed/refractory (r/r) pediatric and young adult acute lymphoblastic leukemia, r/r diffuse large B-cell lymphoma, and r/r follicular lymphoma. This article presents a high-level overview of the clinical development journey of tisagenlecleucel, including its efficacy outcomes and safety considerations.
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Affiliation(s)
- Rakesh Awasthi
- Oncology & Hematology, Novartis Institutes for BioMedical Research, East Hanover, NJ, USA
| | - Harald J Maier
- Oncology and Hematology, Global Drug Development, Novartis Pharma AG, Basel, Switzerland
| | - Jie Zhang
- Cell & Gene Unit, Novartis Services Inc, East Hanover, NJ, USA
| | - Stephen Lim
- US Medical Affairs, Oncology, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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25
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Villeneuve PJA, Bredeson C. CAR-T Cells in Canada; Perspective on How to Ensure We Get Our Value’s Worth. Curr Oncol 2023; 30:4033-4040. [PMID: 37185418 PMCID: PMC10136494 DOI: 10.3390/curroncol30040305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
New therapies in a publicly funded healthcare system are first appraised by health technology assessment agencies that provide funding recommendations to the payers. Treatment with Chimeric Antigen Receptor-T cell (CAR-T) therapy is revolutionizing the management of patients with relapsed/refractory aggressive B-cell lymphoma by providing an effective alternative to the standard of care. Yet, the implementation of CAR-T treatment has a substantial impact on the healthcare system due to its high cost, complex manufacturing process, and requirement for highly specialized services and expertise. CAR-T Cells, as a “living drug”, are fundamentally different from usual medications, and their approvals and funding recommendations pose unique challenges to the health technology agency. In this paper, we explore the specific challenges that face the health technology agencies in reviewing reimbursement recommendations for CAR-T therapy. We take a Canadian perspective and use CAR-T treatment of relapse/refractory aggressive B-cell lymphoma as an example.
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Affiliation(s)
- Pierre J. A. Villeneuve
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
| | - Christopher Bredeson
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
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26
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Liu C, Cojutti PG, Giannella M, Roberto M, Casadei B, Cristiano G, Papayannidis C, Vianelli N, Zinzani PL, Viale P, Bonifazi F, Pea F. Does Cytokine-Release Syndrome Induced by CAR T-Cell Treatment Have an Impact on the Pharmacokinetics of Meropenem and Piperacillin/Tazobactam in Patients with Hematological Malignancies? Findings from an Observational Case-Control Study. Pharmaceutics 2023; 15:pharmaceutics15031022. [PMID: 36986882 PMCID: PMC10059857 DOI: 10.3390/pharmaceutics15031022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a promising approach for some relapse/refractory hematological B-cell malignancies; however, in most patients, cytokine release syndrome (CRS) may occur. CRS is associated with acute kidney injury (AKI) that may affect the pharmacokinetics of some beta-lactams. The aim of this study was to assess whether the pharmacokinetics of meropenem and piperacillin may be affected by CAR T-cell treatment. The study included CAR T-cell treated patients (cases) and oncohematological patients (controls), who were administered 24-h continuous infusion (CI) meropenem or piperacillin/tazobactam, optimized by therapeutic drug monitoring, over a 2-year period. Patient data were retrospectively retrieved and matched on a 1:2 ratio. Beta-lactam clearance (CL) was calculated as CL = daily dose/infusion rate. A total of 38 cases (of whom 14 and 24 were treated with meropenem and piperacillin/tazobactam, respectively) was matched with 76 controls. CRS occurred in 85.7% (12/14) and 95.8% (23/24) of patients treated with meropenem and piperacillin/tazobactam, respectively. CRS-induced AKI was observed in only 1 patient. CL did not differ between cases and controls for both meropenem (11.1 vs. 11.7 L/h, p = 0.835) and piperacillin (14.0 vs. 10.4 L/h, p = 0.074). Our findings suggest that 24-h CI meropenem and piperacillin dosages should not be reduced a priori in CAR T-cell patients experiencing CRS.
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Affiliation(s)
- Chun Liu
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
| | - Pier Giorgio Cojutti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marcello Roberto
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Beatrice Casadei
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gianluca Cristiano
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Cristina Papayannidis
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Nicola Vianelli
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pier Luigi Zinzani
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesca Bonifazi
- Istituto di Ematologia "Seràgnoli", IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Nagler A, Perriello VM, Falini L, Falini B. How I treat refractory/relapsed diffuse large B-cell lymphomas with CD19-directed chimeric antigen receptor T cells. Br J Haematol 2023; 201:396-410. [PMID: 36916189 DOI: 10.1111/bjh.18724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/15/2023]
Abstract
Chimeric antigen receptor (CAR) T cells targeting CD19 represent a promising salvage immunotherapy for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL), offering ~40% of long-term responses. In everyday clinical practice, haematologists involved in CAR T cell treatment of patients with R/R DLBCL have to deal with diagnostically complex cases and difficult therapeutic choices. The availability of novel immunotherapeutic agents for R/R DLBCL and recent advances in understanding CAR T-cell failure mechanisms demand a rational approach to identify the best choice for bridging therapy and managing post-CAR T-cell therapy relapses. Moreover, positron emission tomography/computerised tomography may result in false-positive interpretation, highlighting the importance of post-treatment biopsy. In this review, we discuss all above issues, presenting four instructive cases, with the aim to provide criteria and new perspectives for CAR T-cell treatment of DLBCL.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - Vincenzo Maria Perriello
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Lorenza Falini
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
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Benoit A, B Boies MH, Déry N, M Garcia L, Simard M, Poirier M, Delage R, Lortal Canguilhem B, Doyle C, Larouche JF, Couture F, Lemieux C. CAR T-Cells for the Treatment of Refractory or Relapsed Large B-Cell Lymphoma: A Single-Center Retrospective Canadian Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:203-210. [PMID: 36646606 DOI: 10.1016/j.clml.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T-cells are an important new third-line treatment option for large B-cell lymphoma (LBCL). The objective response rates in pivotal early phase clinical trials with CAR T-cells were very promising. The objective of this study was to describe the efficacy results obtained with CAR T-cells infusions in our institution and to compare the toxicities of our cohort with those of pivotal trials and studies conducted in a real-life setting. PATIENTS AND METHODS Efficacy and safety data were retrospectively collected from 25 patients with LBCL treated with CAR T-cells therapy at CHU de Québec-Université Laval. A literature search was then performed to identify other efficacy or safety data from a real-life setting. RESULTS At 3 months post infusion, the objective response rate (ORR) in our population with tisagenlecleucel and axicabtagene-ciloleucel were 20% and 47%, respectively. Bulky disease was the only negative predictor of poor response at 3 months (0% vs. 53%, P = .03). Bulky disease was associated with a median PFS of 2 months compared to 5 months for non-bulky disease (P = .0009). Grade ≥ 3 hematological toxicities were greater in patients treated with axi-cel (60% vs. 20%, P = .048), without bone marrow involvement (55% vs. 0%, P =.046), without stage IV disease (72% vs. 21%, P =.02), with refractory disease (67% vs. 10%, P =.01) or having been affected by cytokine release syndrome (58% vs. 0%, P =.02). CONCLUSION The poor response rate at 3 months after infusion in our cohort was influenced mainly by bulky disease. Further studies are needed to better characterize the loss of efficacy of CAR T-cells because the majority of patients will relapse over time.
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Affiliation(s)
- Aurélie Benoit
- Department of pharmacy, CHU de Québec - Université Laval, Québec, Québec, Canada; Faculté de pharmacie, Université de Bordeaux, Bordeaux, Nouvelle Aquitaine, France; Unité pour l'usage optimal du médicament et la recherche (UGMR), CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Marie-Hélène B Boies
- Department of pharmacy, CHU de Québec - Université Laval, Québec, Québec, Canada; Unité pour l'usage optimal du médicament et la recherche (UGMR), CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Nicole Déry
- Department of pharmacy, CHU de Québec - Université Laval, Québec, Québec, Canada; Unité pour l'usage optimal du médicament et la recherche (UGMR), CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Luciana M Garcia
- Department of medicine, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Mélanie Simard
- Department of pharmacy, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Mireille Poirier
- Department of pharmacy, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Robert Delage
- Department of medicine, CHU de Québec - Université Laval, Québec, Québec, Canada
| | | | - Catherine Doyle
- Department of medicine, CHU de Québec - Université Laval, Québec, Québec, Canada
| | | | - Félix Couture
- Department of medicine, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Christopher Lemieux
- Department of medicine, CHU de Québec - Université Laval, Québec, Québec, Canada.
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Luksik AS, Yazigi E, Shah P, Jackson CM. CAR T Cell Therapy in Glioblastoma: Overcoming Challenges Related to Antigen Expression. Cancers (Basel) 2023; 15:cancers15051414. [PMID: 36900205 PMCID: PMC10000604 DOI: 10.3390/cancers15051414] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Glioblastoma (GBM) is the most common primary brain tumor, yet prognosis remains dismal with current treatment. Immunotherapeutic strategies have had limited effectiveness to date in GBM, but recent advances hold promise. One such immunotherapeutic advance is chimeric antigen receptor (CAR) T cell therapy, where autologous T cells are extracted and engineered to express a specific receptor against a GBM antigen and are then infused back into the patient. There have been numerous preclinical studies showing promising results, and several of these CAR T cell therapies are being tested in clinical trials for GBM and other brain cancers. While results in tumors such as lymphomas and diffuse intrinsic pontine gliomas have been encouraging, early results in GBM have not shown clinical benefit. Potential reasons for this are the limited number of specific antigens in GBM, their heterogenous expression, and their loss after initiating antigen-specific therapy due to immunoediting. Here, we review the current preclinical and clinical experiences with CAR T cell therapy in GBM and potential strategies to develop more effective CAR T cells for this indication.
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Lu H, Cheng Z, Hu Y, Tang LV. What Can De Novo Protein Design Bring to the Treatment of Hematological Disorders? BIOLOGY 2023; 12:166. [PMID: 36829445 PMCID: PMC9952452 DOI: 10.3390/biology12020166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Protein therapeutics have been widely used to treat hematological disorders. With the advent of de novo protein design, protein therapeutics are not limited to ameliorating natural proteins but also produce novel protein sequences, folds, and functions with shapes and functions customized to bind to the therapeutic targets. De novo protein techniques have been widely used biomedically to design novel diagnostic and therapeutic drugs, novel vaccines, and novel biological materials. In addition, de novo protein design has provided new options for treating hematological disorders. Scientists have designed protein switches called Colocalization-dependent Latching Orthogonal Cage-Key pRoteins (Co-LOCKR) that perform computations on the surface of cells. De novo designed molecules exhibit a better capacity than the currently available tyrosine kinase inhibitors in chronic myeloid leukemia therapy. De novo designed protein neoleukin-2/15 enhances chimeric antigen receptor T-cell activity. This new technique has great biomedical potential, especially in exploring new treatment methods for hematological disorders. This review discusses the development of de novo protein design and its biological applications, with emphasis on the treatment of hematological disorders.
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Affiliation(s)
| | | | | | - Liang V. Tang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Abstract
In recent years, chimeric antigen receptor (CAR) T-cell therapy has emerged as an effective and potentially paradigm-shifting therapy for patients with refractory lymphoma and myeloma. This novel therapy involves engineering T cells to recognize specific antigens on the surface of cancer cells. Several CAR T-cell products are approved by the US Food and Drug Administration as a result of numerous clinical trials. Due to the complexity of these studies and the high level of care required for CAR T-cell therapy patients, the role of the research advanced practice provider (APP) has become increasingly central to the success of CAR T-cell trials. This review article explores the vital role of the research APP in CAR T-cell clinical trials.
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Affiliation(s)
- Ly Dsouza
- From The University of Texas MD Anderson Cancer Center, Houston, Texas
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Shahzad M, Nguyen A, Hussain A, Ammad-Ud-Din M, Faisal MS, Tariq E, Ali F, Butt A, Anwar I, Chaudhary SG, Lutfi F, Ahmed N, Singh AK, Hematti P, McGuirk JP, Mushtaq MU. Outcomes with chimeric antigen receptor t-cell therapy in relapsed or refractory acute myeloid leukemia: a systematic review and meta-analysis. Front Immunol 2023; 14:1152457. [PMID: 37168849 PMCID: PMC10164930 DOI: 10.3389/fimmu.2023.1152457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
Background We conducted a systematic review and meta-analysis to evaluate outcomes following chimeric antigen receptor T cell (CAR-T) therapy in relapsed/refractory acute myeloid leukemia (RR-AML). Methods We performed a literature search on PubMed, Cochrane Library, and Clinicaltrials.gov. After screening 677 manuscripts, 13 studies were included. Data was extracted following PRISMA guidelines. Pooled analysis was done using the meta-package by Schwarzer et al. Proportions with 95% confidence intervals (CI) were computed. Results We analyzed 57 patients from 10 clinical trials and 3 case reports. The pooled complete and overall response rates were 49.5% (95% CI 0.18-0.81, I2 =65%) and 65.2% (95% CI 0.36-0.91, I2 =57%). The pooled incidence of cytokine release syndrome, immune-effector cell associated neurotoxicity syndrome, and graft-versus-host disease was estimated as 54.4% (95% CI 0.17-0.90, I2 =77%), 3.9% (95% CI 0.00-0.19, I2 =22%), and 1.6% (95%CI 0.00-0.21, I2 =33%), respectively. Conclusion CAR-T therapy has demonstrated modest efficacy in RR-AML. Major challenges include heterogeneous disease biology, lack of a unique targetable antigen, and immune exhaustion.
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Affiliation(s)
- Moazzam Shahzad
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
- Moffitt Cancer Center, University of South Florida, Tampa, FL, United States
| | - Andrea Nguyen
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ali Hussain
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Muhammad Salman Faisal
- Division of Hematology/Oncology, Roswell Park Cancer Institute Buffalo, NY, United States
| | - Ezza Tariq
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Fatima Ali
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Atif Butt
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Iqra Anwar
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sibgha Gull Chaudhary
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Forat Lutfi
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Anurag K. Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Peiman Hematti
- Division of Hematology/Oncology, University of Wisconsin School of Medicine & Public Health, Madison, WL, United States
| | - Joseph P. McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Muhammad Umair Mushtaq
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, United States
- *Correspondence: Muhammad Umair Mushtaq,
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Lachance S, Bourguignon A, Boisjoly JA, Bouchard P, Ahmad I, Bambace N, Bernard L, Cohen S, Delisle JS, Fleury I, Kiss T, Mollica L, Roy DC, Sauvageau G, Veilleux O, Zehr J, Chagnon M, Roy J. Impact of Implementing a Bendamustine-Based Conditioning Regimen on Outcomes of Autologous Stem Cell Transplantation in Lymphoma while Novel Cellular Therapies Emerge. Transplant Cell Ther 2023; 29:34.e1-34.e7. [PMID: 36243319 DOI: 10.1016/j.jtct.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
With the advent of new cellular and targeted therapies, treatment options for relapsed and refractory (r/R) lymphomas have multiplied, and the optimal approach offering the best outcomes remains a matter of passionate debate. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is still considered a treatment option for patients with chemosensitive lymphoma when cure is the expected goal. The myeloablative conditioning regimen preceding the stem cell infusion is considered the effective component of this approach. Carmustine (BCNU)-based preparative regimens, such as BEAM and BEAC, are considered the standard of care and have shown efficacy and low nonrelapse mortality (NRM). Comparative studies between conditioning regimens have failed to identify a better option. After a BCNU drug shortage in Canada followed by a steep increase in price, we elected to substitute BCNU for bendamustine (benda) in the preparative regimen. The purpose of this substitution was to improve response while preserving safety and controlling costs. From May 2015 to May 2018, a total of 131 consecutive lymphoma patients received benda-EAM conditioning. These patients were compared with 96 consecutive patients who received BCNU-based conditioning from January 2012 to May 2015. Apart from conditioning, supportive care measures were the same in the 2 groups. Patients receiving benda were older (55.7 years versus 51.1 years; P = .002). The development of grade ≥3 mucositis was more frequent with benda conditioning (39.5% versus 7.8%; P < .001) leading to a greater requirement for parenteral nutrition (48.9% versus 21.9%; P < .001). A transient creatinine increase >1.5 times the upper limit of normal (15.3% versus 4.2%; P < .008) and intensive care unit admission (6.9% versus 1.1%; P < .029) were more frequent with benda; however, there were no between-group differences in cardiac, pulmonary, or liver toxicity and NRM. With a median follow-up of 48 months for the benda group and 60 months for the BCNU group, benda was associated with significantly better progression-free survival (71% versus 61%; P = .040; hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.0 to 2.7) and overall survival (86% vs 71%; P = .0066; HR, 2.6; 95% CI, 1.3 to 5.4) compared with BCNU-based conditioning regimens. While novel therapies emerge, our study demonstrates that benda-EAM is safe and effective and should be considered a valid alternative to BCNU conditioning to improve outcomes of patients with chemosensitive r/R lymphomas undergoing ASCT.
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Affiliation(s)
- Sylvie Lachance
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada.
| | - Alex Bourguignon
- Division of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Josie-Anne Boisjoly
- Division of Hematology and Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Philippe Bouchard
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Imran Ahmad
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Nadia Bambace
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Léa Bernard
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Sandra Cohen
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Delisle
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Fleury
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Thomas Kiss
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Luigina Mollica
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Denis-Claude Roy
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Guy Sauvageau
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Veilleux
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Justine Zehr
- Department of Medicine and Biostatistics, Université de Montréal, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Miguel Chagnon
- Department of Medicine and Biostatistics, Université de Montréal, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Roy
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular Therapy, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; Hopital Maisonneuve-Rosemont, Division of Hematology, Oncology, Hematopoietic Cell Transplant and Cellular therapy, Université de Montréal, Montreal, Quebec, Canada
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Dickinson MJ, Carlo-Stella C, Morschhauser F, Bachy E, Corradini P, Iacoboni G, Khan C, Wróbel T, Offner F, Trněný M, Wu SJ, Cartron G, Hertzberg M, Sureda A, Perez-Callejo D, Lundberg L, Relf J, Dixon M, Clark E, Humphrey K, Hutchings M. Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med 2022; 387:2220-2231. [PMID: 36507690 DOI: 10.1056/nejmoa2206913] [Citation(s) in RCA: 217] [Impact Index Per Article: 108.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prognosis for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) is poor. Glofitamab is a bispecific antibody that recruits T cells to tumor cells. METHODS In the phase 2 part of a phase 1-2 study, we enrolled patients with relapsed or refractory DLBCL who had received at least two lines of therapy previously. Patients received pretreatment with obinutuzumab to mitigate cytokine release syndrome, followed by fixed-duration glofitamab monotherapy (12 cycles total). The primary end point was complete response according to assessment by an independent review committee. Key secondary end points included duration of response, survival, and safety. RESULTS Of the 155 patients who were enrolled, 154 received at least one dose of any study treatment (obinutuzumab or glofitamab). At a median follow-up of 12.6 months, 39% (95% confidence interval [CI], 32 to 48) of the patients had a complete response according to independent review. Results were consistent among the 52 patients who had previously received chimeric antigen receptor T-cell therapy (35% of whom had a complete response). The median time to a complete response was 42 days (95% CI, 42 to 44). The majority (78%) of complete responses were ongoing at 12 months. The 12-month progression-free survival was 37% (95% CI, 28 to 46). Discontinuation of glofitamab due to adverse events occurred in 9% of the patients. The most common adverse event was cytokine release syndrome (in 63% of the patients). Adverse events of grade 3 or higher occurred in 62% of the patients, with grade 3 or higher cytokine release syndrome in 4% and grade 3 or higher neurologic events in 3%. CONCLUSIONS Glofitamab therapy was effective for DLBCL. More than half the patients had an adverse event of grade 3 or 4. (Funded by F. Hoffmann-La Roche; ClinicalTrials.gov number, NCT03075696.).
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MESH Headings
- Humans
- Cytokine Release Syndrome/chemically induced
- Cytokine Release Syndrome/prevention & control
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/immunology
- Neoplasm Recurrence, Local/drug therapy
- Antibodies, Bispecific/adverse effects
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/therapeutic use
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Affiliation(s)
- Michael J Dickinson
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Carmelo Carlo-Stella
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Franck Morschhauser
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Emmanuel Bachy
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Paolo Corradini
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Gloria Iacoboni
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Cyrus Khan
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Tomasz Wróbel
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Fritz Offner
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Marek Trněný
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Shang-Ju Wu
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Guillaume Cartron
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Mark Hertzberg
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Anna Sureda
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - David Perez-Callejo
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Linda Lundberg
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - James Relf
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Mark Dixon
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Emma Clark
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Kathryn Humphrey
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
| | - Martin Hutchings
- From the Peter MacCallum Cancer Centre, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, VIC (M.J.D.), and Prince of Wales Hospital and the University of New South Wales, Sydney (M. Hertzberg) - all in Australia; Humanitas University and Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital (C.C.-S.), and Università degli Studi di Milano and Fondazione IRCCS Istituto Nazionale dei Tumori (P.C.) - all in Milan; Université de Lille, Centre Hospitalier Universitaire (CHU) Lille, Unité Labellisée de Recherche 7365, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille (F.M.), Centre Hospitalier Lyon Sud, Lyon (E.B.), and CHU de Montpellier, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5535, Montpellier (G.C.) - all in France; Vall d'Hebron University Hospital (G.I.) and Institut Català d'Oncologia Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (A.S.) - both in Barcelona; the Allegheny Health Network Cancer Institute, Pittsburgh (C.K.); Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland (T.W.); Universitair Ziekenhuis Gent, Ghent, Belgium (F.O.); the First Faculty of Medicine, Charles University Hospital, Prague, Czech Republic (M.T.); National Taiwan University Hospital, Taipei (S.-J.W.); F. Hoffmann-La Roche, Basel, Switzerland (D.P.-C., L.L.); Roche Products, Welwyn Garden City, United Kingdom (J.R., M.D., E.C., K.H.); and Rigshospitalet, Copenhagen (M. Hutchings)
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Messori A, Chiumente M, Mengato D. Chimeric Antigen Receptor T Cells in Large B-Cell Lymphoma: Analysis of Overall Survival Based on Reconstructed Patient-Level Data. Clin Ther 2022; 44:1626-1632. [DOI: 10.1016/j.clinthera.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
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Transgenic expression of IL-7 regulates CAR-T cell metabolism and enhances in vivo persistence against tumor cells. Sci Rep 2022; 12:12506. [PMID: 35869100 PMCID: PMC9307822 DOI: 10.1038/s41598-022-16616-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractChimeric antigen receptor (CAR) T-cell therapy has emerged as a promising novel therapeutic approach. However, primary and secondary resistance to CAR-T cell therapy is commonly encountered in various clinical trials. Despite the comprehensive studies to elucidate the mechanisms of resistance, effective resolution in clinical practice is still elusive. Inadequate persistence and subsequent loss of infused CAR-T cells are proposed major resistance mechanism associated with CAR-T cell treatment failure. Thus, we generated CAR-T cells armored with IL-7 to prolong the persistence of infused T-cells, particularly CD4 + T cells, and enhanced anti-tumor response. IL-7 increased CAR-T-cell persistence in vivo and contributed to the distinct T-cell cytotoxicity profile. Using mass cytometry (CyTOF), we further assessed the phenotypic and metabolic profiles of IL-7-secreting CAR-T cells, along with conventional CAR-T cells at the single-cell level. With in-depth analysis, we found that IL-7 maintained CAR-T cells in a less differentiated T-cell state, regulated distinct metabolic activity, and prevented CAR-T-cell exhaustion, which could be essential for CAR-T cells to maintain their metabolic fitness and anti-tumor response. Our findings thus provided clinical rationale to exploit IL-7 signaling for modulation and metabolic reprogramming of T-cell function to enhance CAR-T cell persistence and induce durable remission upon CAR-T cell therapy.
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Goldsmith SR, Ghobadi A, Dipersio JF, Hill B, Shadman M, Jain T. Chimeric Antigen Receptor T Cell Therapy versus Hematopoietic Stem Cell Transplantation: An Evolving Perspective. Transplant Cell Ther 2022; 28:727-736. [PMID: 35878743 PMCID: PMC10487280 DOI: 10.1016/j.jtct.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/30/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
Abstract
Cellular therapy modalities, including autologous (auto-) hematopoietic cell transplantation (HCT), allogeneic (allo-) HCT, and now chimeric antigen receptor (CAR) T cell therapy, have demonstrated long-term remission in advanced hematologic malignancies. Auto-HCT and allo-HCT, through hematopoietic rescue, have permitted the use of higher doses of chemotherapy. Allo-HCT also introduced a nonspecific immune-mediated targeting of malignancy resulting in protection from relapse, although at the expense of similar targeting of normal host cells. In contrast, CAR T therapy, through genetically engineered immunotherapeutic precision, allows for redirection of autologous immune effector cells against malignancy in an antigen-specific and MHC-independent fashion, with demonstrated efficacy in patients who are refractory to cytotoxic chemotherapy. It too has unique toxicities and challenges, however. Non-Hodgkin lymphoma (including large B cell lymphoma, mantle cell lymphoma, and follicular lymphoma), B cell acute lymphoblastic leukemia, and multiple myeloma are the 3 main diseases associated with the use of fully developed CAR T products with widespread deployment. Recent and ongoing clinical trials have been examining the interface among the 3 cellular therapy modalities (auto-HCT, allo-HCT, and CAR T) to determine whether they should be "complementary" or "competitive" therapies. In this review, we examine the current state of this interface with respect to the most recent data and delve into the controversies and conclusions that may inform clinical decision making.
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Affiliation(s)
- Scott R Goldsmith
- Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope Comprehensive Cancer Center, Duarte, California; Division of Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri.
| | - Armin Ghobadi
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John F Dipersio
- Division of Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Brian Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mayzar Shadman
- Clinical Research Division, Fred Hutch Cancer Center and Medical Oncology division, University of Washington, Seattle, Washington
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Campisi M, Shelton SE, Chen M, Kamm RD, Barbie DA, Knelson EH. Engineered Microphysiological Systems for Testing Effectiveness of Cell-Based Cancer Immunotherapies. Cancers (Basel) 2022; 14:3561. [PMID: 35892819 PMCID: PMC9330888 DOI: 10.3390/cancers14153561] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/06/2023] Open
Abstract
Cell therapies, including adoptive immune cell therapies and genetically engineered chimeric antigen receptor (CAR) T or NK cells, have shown promise in treating hematologic malignancies. Yet, immune cell infiltration and expansion has proven challenging in solid tumors due to immune cell exclusion and exhaustion and the presence of vascular barriers. Testing next-generation immune therapies remains challenging in animals, motivating sophisticated ex vivo models of human tumor biology and prognostic assays to predict treatment response in real-time while comprehensively recapitulating the human tumor immune microenvironment (TIME). This review examines current strategies for testing cell-based cancer immunotherapies using ex vivo microphysiological systems and microfluidic technologies. Insights into the multicellular interactions of the TIME will identify novel therapeutic strategies to help patients whose tumors are refractory or resistant to current immunotherapies. Altogether, these microphysiological systems (MPS) have the capability to predict therapeutic vulnerabilities and biological barriers while studying immune cell infiltration and killing in a more physiologically relevant context, thereby providing important insights into fundamental biologic mechanisms to expand our understanding of and treatments for currently incurable malignancies.
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Affiliation(s)
- Marco Campisi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; (M.C.); (S.E.S.); (M.C.); (D.A.B.)
| | - Sarah E. Shelton
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; (M.C.); (S.E.S.); (M.C.); (D.A.B.)
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
| | - Minyue Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; (M.C.); (S.E.S.); (M.C.); (D.A.B.)
- Department of Immunology, Harvard Medical School, Boston, MA 02115, USA
| | - Roger D. Kamm
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - David A. Barbie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; (M.C.); (S.E.S.); (M.C.); (D.A.B.)
| | - Erik H. Knelson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; (M.C.); (S.E.S.); (M.C.); (D.A.B.)
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Frontzek F, Karsten I, Schmitz N, Lenz G. Current options and future perspectives in the treatment of patients with relapsed/refractory diffuse large B-cell lymphoma. Ther Adv Hematol 2022; 13:20406207221103321. [PMID: 35785244 PMCID: PMC9243592 DOI: 10.1177/20406207221103321] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/10/2022] [Indexed: 12/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents the most common subtype of
aggressive lymphoma. Depending on individual risk factors, roughly 60–65% of
patients can be cured by chemoimmunotherapy with rituximab, cyclophosphamide,
doxorubicin, vincristine, and prednisone (R-CHOP). However, patients with
primary refractory disease or relapse (R/R) after an initial response are still
characterized by poor outcome. Until now, transplant-eligible R/R DLBCL patients
are treated with intensive salvage regimens followed by high-dose chemotherapy
and autologous stem cell transplantation (ASCT) which, however, only cures a
limited number of patients. It is most likely that in patients with early
relapse after chemoimmunotherapy, chimeric antigen receptor (CAR) T-cells will
replace high-dose chemotherapy and ASCT. So far, transplant-ineligible patients
have mostly been treated in palliative intent. Recently, a plethora of novel
agents comprising new monoclonal antibodies, antibody drug conjugates (ADC),
bispecific antibodies, and CAR T-cells have emerged and have significantly
improved outcome of patients with R/R DLBCL. In this review, we summarize our
current knowledge on the usage of novel drugs and approaches for the treatment
of patients with R/R DLBCL.
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Affiliation(s)
- Fabian Frontzek
- Department of Medicine A for Hematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Imke Karsten
- Department of Medicine A for Hematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Norbert Schmitz
- Department of Medicine A for Hematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Georg Lenz
- Department of Medicine A for Hematology, Oncology, and Pneumology, University Hospital Münster, 48149 Münster, Germany
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Schroeder BA, Jess J, Sankaran H, Shah NN. Clinical trials for chimeric antigen receptor T-cell therapy: lessons learned and future directions. Curr Opin Hematol 2022; 29:225-232. [PMID: 35787551 PMCID: PMC9354650 DOI: 10.1097/moh.0000000000000723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the status and utilization of chimeric antigen receptor T-cell (CAR-T) therapy based on the most recent clinical trials in patients with leukemia and lymphoma. Additionally, this review will highlight limitations in current strategies, discuss efforts in toxicity mitigation, and outline future directions for investigation. RECENT FINDINGS CD19 targeted CAR-T-cell therapy (CD19-CAR) is highly effective in patients with relapsed/refractory (r/r) B-cell hematologic malignancies. However, multiple challenges have arisen, particularly life-threatening adverse events, such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Despite these challenges, recent CD19-CAR trials, including two randomized studies, have demonstrated both impressive initial results along with durable responses. Combined with results emerging from 'real-world' experience, the efficacy of CAR-T-cells is high, propelling CAR-T-cells studies targeting alternate B-cell antigens [e.g. CD20, CD22 and CD269 (BCMA)] and other targets for hematologic malignancies, along with solid and CNS tumors. SUMMARY Given the benefit for CD19-CAR, determining the appropriate place in utilization for both an individual patient's treatment course and more broadly in the generalized treatment paradigm is critically needed. We discuss the most recent trials exploring this topic and future directions in the field.
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Affiliation(s)
- Brett A Schroeder
- National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Jennifer Jess
- Pediatric Oncology Branch, Center for Cancer Research (CCR)
| | - Hari Sankaran
- Biometric Research Program, Division of Cancer Treatment and Diagnosis
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research (CCR)
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Sudarsanam H, Buhmann R, Henschler R. Influence of Culture Conditions on Ex Vivo Expansion of T Lymphocytes and Their Function for Therapy: Current Insights and Open Questions. Front Bioeng Biotechnol 2022; 10:886637. [PMID: 35845425 PMCID: PMC9277485 DOI: 10.3389/fbioe.2022.886637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/16/2022] [Indexed: 01/03/2023] Open
Abstract
Ex vivo expansion of T lymphocytes is a central process in the generation of cellular therapies targeted at tumors and other disease-relevant structures, which currently cannot be reached by established pharmaceuticals. The influence of culture conditions on T cell functions is, however, incompletely understood. In clinical applications of ex vivo expanded T cells, so far, a relatively classical standard cell culture methodology has been established. The expanded cells have been characterized in both preclinical models and clinical studies mainly using a therapeutic endpoint, for example antitumor response and cytotoxic function against cellular targets, whereas the influence of manipulations of T cells ex vivo including transduction and culture expansion has been studied to a much lesser detail, or in many contexts remains unknown. This includes the circulation behavior of expanded T cells after intravenous application, their intracellular metabolism and signal transduction, and their cytoskeletal (re)organization or their adhesion, migration, and subsequent intra-tissue differentiation. This review aims to provide an overview of established T cell expansion methodologies and address unanswered questions relating in vivo interaction of ex vivo expanded T cells for cellular therapy.
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Affiliation(s)
| | | | - Reinhard Henschler
- Institute of Transfusion Medicine, University Hospital Leipzig, Leipzig, Germany
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BeEAM High-Dose Chemotherapy with Polatuzumab (Pola-BeEAM) before ASCT in Patients with DLBCL—A Pilot Study. J Clin Med 2022; 11:jcm11133748. [PMID: 35807041 PMCID: PMC9267272 DOI: 10.3390/jcm11133748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Introduction: BEAM is a high-dose chemotherapy (HDCT) frequently administered before autologous stem cell transplantation (ASCT) in diffuse large B-cell lymphoma (DLBCL). Bendamustine replacing BCNU (BeEAM) is similarly effective at lower toxicities. However, relapse remains the major cause of death in DLBCL. (2) Methods: This is a 12-patient pilot study of the BeEAM preparative regimen with additional polatuzumab vedotin (PV, targeting CD79b) aiming to establish feasibility and to reduce toxicity without increasing the early progression rate. PV was given once at the standard dose of 1.8 mg/kg at day −6 together with BeEAM-HDCT (days −7 to −1) before ASCT. (3) Results: 8/12 patients (67%) received PV with BeEAM as a consolidation of first-line treatment, and 4/12 patients (33%) received PV with BeEAM after relapse treatment. All patients experienced complete engraftment (neutrophils: median 11 days; platelets: 13 days). Gastrointestinal toxicities occurred in 7/12 patients (58%, grade 3). All patients developed neutropenic infections with at least one identified pathogen (bacterial: 10/12 patients; viral: 2/12; and fungal: 1/12). The complete remission rate by PET-CT 100 days post-ASCT was 92%, with one mortality due to early progression. Eleven out of twelve patients (92%) were alive without progression after a median follow-up of 15 months. (4) Conclusions: Our study with 12 patients suggests that combining PV with BeEAM HDCT is feasible and safe, but the limited cohort prevents definite conclusions regarding efficacy. Larger cohorts must be evaluated.
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CAR T-cell Therapy in Highly-Aggressive B-Cell Lymphoma: Emerging Biological and Clinical Insights. Blood 2022; 140:1461-1469. [PMID: 35560330 DOI: 10.1182/blood.2022016226] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Recently, significant progress has been made in identifying novel therapies, beyond conventional immunochemotherapy strategies, with efficacy in B-cell lymphomas. One such approach involves targeting the CD19 antigen on B-cells with autologous-derived chimeric antigen receptor (CAR) cells. This strategy is highly effective in patients with relapsed and refractory diffuse large B-cell lymphoma (DLBCL) as evidenced by recent regulatory approvals. Recent reports suggest that this is an effective strategy for high-grade B-cell. The biological underpinnings of these entities and how they overlap with each other and DLBCL continue to be areas of intense investigation. Therefore, as more experience with CAR T-cell approaches is examined, it is interesting to consider how both tumor-cell specific and microenvironment factors that define these highly aggressive subsets influence susceptibility to this approach.
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Grigg A. Living Long and Well After an Autograft. J Clin Oncol 2022; 40:1971-1975. [PMID: 35512253 DOI: 10.1200/jco.22.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew Grigg
- Department Clinical Haematology, Austin Hospital, Heidelberg, Melbourne, Australia
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Neelapu SS, Dickinson M, Munoz J, Ulrickson ML, Thieblemont C, Oluwole OO, Herrera AF, Ujjani CS, Lin Y, Riedell PA, Kekre N, de Vos S, Lui C, Milletti F, Dong J, Xu H, Chavez JC. Axicabtagene ciloleucel as first-line therapy in high-risk large B-cell lymphoma: the phase 2 ZUMA-12 trial. Nat Med 2022; 28:735-742. [PMID: 35314842 PMCID: PMC9018426 DOI: 10.1038/s41591-022-01731-4] [Citation(s) in RCA: 137] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/19/2022]
Abstract
High-risk large B-cell lymphoma (LBCL) has poor outcomes with standard first-line chemoimmunotherapy. In the phase 2, multicenter, single-arm ZUMA-12 study (ClinicalTrials.gov NCT03761056) we evaluated axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, as part of first-line treatment in 40 patients with high-risk LBCL. This trial has completed accrual. The primary outcome was complete response rate (CRR). Secondary outcomes were objective response rate (ORR), duration of response (DOR), event-free survival (EFS), progression-free survival (PFS), overall survival (OS), assessment of safety, central nervous system (CNS) relapse and blood levels of CAR T cells and cytokines. The primary endpoint in efficacy-evaluable patients (n = 37) was met, with 78% CRR (95% confidence interval (CI), 62-90) and 89% ORR (95% CI, 75-97). As of 17 May 2021 (median follow-up, 15.9 months), 73% of patients remained in objective response; median DOR, EFS and PFS were not reached. Grade ≥3 cytokine release syndrome (CRS) and neurologic events occurred in three patients (8%) and nine patients (23%), respectively. There were no treatment-related grade 5 events. Robust CAR T-cell expansion occurred in all patients with a median time to peak of 8 days. We conclude that axi-cel is highly effective as part of first-line therapy for high-risk LBCL, with a manageable safety profile.
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Affiliation(s)
- Sattva S Neelapu
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Michael Dickinson
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia
| | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | | | - Catherine Thieblemont
- Université de Paris, AP-HP, Hôpital Saint-Louis, Hemato-oncology, DMU HI, Paris, France
- Research Unit NF-kappaB, Différenciation et Cancer, Paris, France
| | | | | | - Chaitra S Ujjani
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
| | | | - Natasha Kekre
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sven de Vos
- David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | | | | | | | - Hairong Xu
- Kite, a Gilead Company, Santa Monica, CA, USA
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Karschnia P, Rejeski K, Winkelmann M, Schöberl F, Bücklein VL, Blumenberg V, Schmidt C, Blobner J, von Bergwelt-Baildon M, Tonn JC, Kunz WG, Subklewe M, von Baumgarten L. Toxicities and Response Rates of Secondary CNS Lymphoma After Adoptive Immunotherapy With CD19-Directed Chimeric Antigen Receptor T Cells. Neurology 2022; 98:884-889. [PMID: 35351785 PMCID: PMC9169944 DOI: 10.1212/wnl.0000000000200608] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Secondary CNS involvement in systemic B-cell lymphoma (SCNSL) is difficult to treat and displays dismal clinical outcomes. Chimeric antigen receptor (CAR) T cells emerged as a powerful treatment for systemic lymphoma. We aimed to evaluate whether CAR T cells also represent a safe and effective therapy for SCNSL. Methods We retrospectively searched our institutional database for patients with SCNSL treated with CD19-directed CAR T cells. Results We identified 10 cases, including 7 patients with intraparenchymal lesions and 3 patients with leptomeningeal disease. CNS staging at 1 month after CAR T-cell transfusion showed disease response (stable disease, partial response, and complete response) in 7 patients (70%), including 2 cases of long-lasting complete response (20%). One patient developed pseudoprogression, which resolved under steroids. Response of CNS disease was associated with systemic 1-month response. With a median follow-up of 6 months, median overall and systemic progression-free survival was 7 and 3 months, respectively. Neurotoxic symptoms occurred in 6 patients, with 3 patients developing severe neurotoxicity (American Society for Transplantation and Cellular Therapy grade ≥3). Discussion CAR T cells induce considerable antitumor effects in SCNSL, and CNS response reflects systemic response. Neurotoxicity appears similar to previous reports on patients with lymphoma without CNS involvement. CAR T cells may therefore represent an effective and safe therapy for SCNSL.
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Affiliation(s)
- Philipp Karschnia
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Kai Rejeski
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Michael Winkelmann
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Florian Schöberl
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Veit L Bücklein
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Viktoria Blumenberg
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Christian Schmidt
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Jens Blobner
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Michael von Bergwelt-Baildon
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Joerg-Christian Tonn
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Wolfgang G Kunz
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Marion Subklewe
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
| | - Louisa von Baumgarten
- From the Department of Neurosurgery (P.K., J.B., J.-C.T., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; German Cancer Consortium (DKTK) (P.K., K.R., V.B., C.S., J.B., M.B.-B., J.-C.T., M.S., L.B.), Partner Site Munich; Department of Medicine III - Hematology/Oncology (K.R., V.L.B., V.B., C.S., M.B.-B., M.S.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; Department of Radiology (M.W., W.G.K.), University Hospital, LMU (Ludwig-Maximilians-University) Munich; and Department of Neurology (F.S., L.B.), University Hospital, LMU (Ludwig-Maximilians-University) Munich, Germany
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