1
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Elsemary MT, Maritz MF, Smith LE, Warkiani ME, Thierry B. Enrichment of T-lymphocytes from leukemic blood using inertial microfluidics toward improved chimeric antigen receptor-T cell manufacturing. Cytotherapy 2024:S1465-3249(24)00714-X. [PMID: 38819362 DOI: 10.1016/j.jcyt.2024.05.005] [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: 02/29/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
Chimeric antigen receptor cell therapy is a successful immunotherapy for the treatment of blood cancers. However, hurdles in their manufacturing remain including efficient isolation and purification of the T-cell starting material. Herein, we describe a one-step separation based on inertial spiral microfluidics for efficient enrichment of T-cells in B-cell acute lymphoblastic leukemia (ALL) and B-cell chronic lymphocytic leukemia patient's samples. In healthy donors used to optimize the process, the lymphocyte purity was enriched from 65% (SD ± 0.2) to 91% (SD ± 0.06) and T-cell purity was enriched from 45% (SD ± 0.1) to 73% (SD ± 0.02). Leukemic samples had higher starting B-cells compared to the healthy donor samples. Efficient enrichment and recovery of lymphocytes and T-cells were achieved in ALL samples with B-cells, monocytes and leukemic blasts depleted by 80% (SD ± 0.09), 89% (SD ± 0.1) and 74% (SD ± 0.09), respectively, and a 70% (SD ± 0.1) T-cell recovery. Chronic lymphocytic leukemia samples had lower T-cell numbers, and the separation process was less efficient compared to the ALL. This study demonstrates the use of inertial microfluidics for T-cell enrichment and depletion of B-cell blasts in ALL, suggesting its potential to address a key bottleneck of the chimeric antigen receptor-T manufacturing workflow.
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Affiliation(s)
- Mona T Elsemary
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | - Michelle F Maritz
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | - Louise E Smith
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia
| | | | - Benjamin Thierry
- Future Industries Institute, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, Australia.
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2
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Sebastián E, Andrés Esteban EM, González‐Vicent M, González de Pablo J, Zubicaray J, Gálvez E, Guillén M, Ruiz Pato J, Molina B, Albi G, Ramírez M, Castillo A, Pérez Maroto F, Madero L, Díaz MÁ, Sevilla J. Extracorporeal photopheresis in paediatric patients: A retrospective comparison between different ‘off‐line’ protocols. Vox Sang 2022; 117:1220-1229. [DOI: 10.1111/vox.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Sebastián
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva María Andrés Esteban
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
- Applied Economics Department Universidad Rey Juan Carlos Madrid Spain
| | | | | | - Josune Zubicaray
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva Gálvez
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - María Guillén
- Hematology Department Hospital Universitario Miguel Servet Zaragoza Spain
| | - Julia Ruiz Pato
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Blanca Molina
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Gustavo Albi
- Radiology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Manuel Ramírez
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Ana Castillo
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Florencio Pérez Maroto
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Luis Madero
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Miguel Ángel Díaz
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Julián Sevilla
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
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3
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Harrer DC, Heidenreich M, Fante MA, Müller V, Haehnel V, Offner R, Burkhardt R, Herr W, Edinger M, Wolff D, Thomas S, Brosig A. Apheresis for chimeric antigen receptor T‐cell production in adult lymphoma patients. Transfusion 2022; 62:1602-1611. [DOI: 10.1111/trf.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Dennis Christoph Harrer
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Martin Heidenreich
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Matthias Alexander Fante
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Viktoria Müller
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine University Hospital Regensburg Regensburg Germany
| | - Viola Haehnel
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine University Hospital Regensburg Regensburg Germany
| | - Robert Offner
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine University Hospital Regensburg Regensburg Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine University Hospital Regensburg Regensburg Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Matthias Edinger
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
| | - Simone Thomas
- Department of Internal Medicine III, Hematology and Oncology University Hospital Regensburg Regensburg Germany
- Leibniz Institute for Immunotherapy Division of Genetic‐Immunotherapy Regensburg Germany
| | - Andreas Brosig
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine University Hospital Regensburg Regensburg Germany
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4
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Considerations for immune effector cell therapy collections: a white paper from the American Society for Apheresis. Cytotherapy 2022; 24:916-922. [DOI: 10.1016/j.jcyt.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
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5
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Carnoy S, Beaumont JL, Kanouni T, Parquet N, Beauvais D, Hequet O, Kanold J, Ballot C, Mialou V, Reppel L, Damaj G, Yakoub-Agha I, Chabannon C. [How to perform leukapheresis for procurement of the staring material used for commercial CAR T-cell manufacturing: A consensus from experts convened by the SFGM-TC]. Bull Cancer 2021; 108:295-303. [PMID: 33610284 DOI: 10.1016/j.bulcan.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
Chimeric antigen receptor (CAR) T-cells are a new class of cancer treatments manufactured through autologous or allogeneic T cells genetic engineering to induce CAR expression directed against a membrane antigen present at the surface of malignant cells. In Europe, tisagenlecleucel (Kymriah™) has a marketing authorization for the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia in children and young adults and for the relapsed/refractory diffuse large B-cell lymphoma (DLBCL). The marketing authorization for axicabtagene ciloleucel (Yescarta™) is the treatment of relapsed/refractory DLBCL and mediastinal B-cell lymphoma. Both products are "living drugs" and genetically modified autologous T cells directed against CD19 which is an antigen expressed throughout B lymphoid differentiation and on many B malignancies. This collaborative work - part of a series of expert works on the topic - aims to provide practical advice to assist collection facilities that procure the starting material i.e. blood mononuclear cells for autologous CAR T-cell manufacturing.
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Affiliation(s)
- Sylvie Carnoy
- EFS Nord de France, site de Lille, 38-42, avenue Charles-Saint-Venant, 59000 Lille, France
| | - Jean-Louis Beaumont
- CHU de Henri-Mondor CRETEIL-UPEC, unité d'aphérèses thérapeutiques, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Tarik Kanouni
- CHU de Montpellier, service d'hématologie, unité d'hémaphrèse, 19, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - Nathalie Parquet
- AP-HP, hôpital Saint-Louis, service aphérèse thérapeutique, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - David Beauvais
- University Lille, CHU de Lille, Department of Hematology, 2, avenue Oscar-Lambret, 59000 Lille, France.
| | - Olivier Hequet
- Hospices civils de Lyon, établissement français du sang, Departement of Apheresis, Inserm U1111, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Justina Kanold
- CHU de Clermont-Ferrand, Department of Pediatric Hematology and Oncology, CIC Inserm 501, 1, rue Lucie-et-Raymond-Aubrac, 63100 Clermont-Ferrand, France
| | - Caroline Ballot
- EFS Nord de France, laboratoire de thérapie cellulaire et banque de sang placentaire, site de Lille-Belfort, 10, boulevard de Belfort, 59000 Lille, France
| | - Valérie Mialou
- Hôpital E.-Herriot, banque de tissus et cellules, établissement français du sang, 5, place d'Arsonval, 69003 Lyon, France
| | - Loïc Reppel
- CHRU de Nancy, unité de thérapie cellulaire et banque de tissus, rue du Morvan, 54511 Vandœuvre-les-Nancy cedex, France
| | - Gandhi Damaj
- Université de Caen-Normandie, CHU de Caen, institut d'hématologie, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Ibrahim Yakoub-Agha
- Université Lille, CHU de Lille, Infinite, U1286, Inserm, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Christian Chabannon
- Aix-Marseille University, institut Paoli-Calmettes Comprehensive Cancer Center, centre de thérapie cellulaire, Inserm CBT-1409, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
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6
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Jarisch A, Rettinger E, Sörensen J, Klingebiel T, Schäfer R, Seifried E, Bader P, Bonig H. Unstimulated apheresis for chimeric antigen receptor manufacturing in pediatric/adolescent acute lymphoblastic leukemia patients. J Clin Apher 2020; 35:398-405. [PMID: 32750197 DOI: 10.1002/jca.21812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Autologous unstimulated leukapheresis product serves as starting material for a variety of innovative cell therapy products, including chimeric antigen receptor (CAR)-modified T-cells. Although it may be reasonable to assume feasibility and efficiency of apheresis for CAR-T cell manufacture, several idiosyncrasies of these patients warrant their separate analysis: target cells (mononuclear cells [MNC] and T-cells) are relatively few which may instruct the selection of apheresis technology, low body weight, and, hence, low total blood volume (TBV) can restrict process and product volume, and patients may be in compromised health. We here report outcome data from 46 consecutive leukaphereses in 33 unique pediatric patients performed for the purpose of CD19-CAR-T-cell manufacturing. Apheresis targets of 2×109 MNC/1×109 T-cells were defined by marketing authorization holder specification. Patient weight was 8 to 84 kg; TBV was 0.6 to 5.1 L. Spectra Optia apheresis technology was used. For 23 patients, a single apheresis sufficed to generate enough cells and manufacture CAR-T-cells, the remainder required two aphereses to meet target dose and/or two apheresis series because of production failure. Aphereses were technically feasible and clinically tolerable without serious adverse effects. The median collection efficiencies for MNC and T-cells were 53% and 56%, respectively. In summary, CAR apheresis in pediatric patients, including the very young, is feasible, safe and efficient, but the specified cell dose targets can be challenging in smaller children. Continuous monitoring of apheresis outcomes is advocated in order to maintain quality.
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Affiliation(s)
- Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
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7
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Reddy OL, Stroncek DF, Panch SR. Improving CAR T cell therapy by optimizing critical quality attributes. Semin Hematol 2020; 57:33-38. [PMID: 32892841 PMCID: PMC7518470 DOI: 10.1053/j.seminhematol.2020.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Whether as a cure or bridge to transplant, chimeric antigen receptor (CAR)-T cell therapies have shown dramatic outcomes for the treatment of hematologic malignancies, and particularly relapsed/refractory B cell leukemia and lymphoma. However, these therapies are not effective for all patients, and are not without toxicities. The challenge now is to optimize these products and their manufacture. The manufacturing process is complex and subject to numerous variabilities at each step. These variabilities can affect the critical quality attributes of the final product, and this can ultimately impact clinical outcomes. This review will focus on optimizing the manufacturing variables that can impact the safety, purity, potency, consistency and durability of CAR-T cells.
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8
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Allen ES, Conry-Cantilena C. Mobilization and collection of cells in the hematologic compartment for cellular therapies: Stem cell collection with G-CSF/plerixafor, collecting lymphocytes/monocytes. Semin Hematol 2019; 56:248-256. [PMID: 31836031 DOI: 10.1053/j.seminhematol.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
An essential and influential first step in all cellular therapies is collecting donor or patient cells. In hematopoietic progenitor cell transplantation, autologous or allogeneic hematopoietic progenitor cells (HPCs) are collected from either the bone marrow or the peripheral blood. Peripheral blood collection by apheresis requires mobilization with chemotherapy, granulocyte colony stimulating factor (G-CSF), plerixafor, or a combination. The modalities of mobilization and collection each carry a unique set of risks and benefits for both the donor and the recipient. In other types of cell therapy, most notably chimeric antigen receptor T cells, lymphocytes or monocytes are collected from the peripheral blood. The risks of collecting these cells by apheresis are similar to HPCs, but less is known about the composition, timing and qualitative cell characteristics which contribute to an optimal collection. Here, we review the mobilization and collection of HPCs and the collection of lymphocytes and monocytes. Donor safety is of primary importance when collecting material for any type of cell therapy. Every aspect of mobilization and collection can be studied and potentially optimized to improve patient outcomes.
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA.
| | - Cathy Conry-Cantilena
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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9
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Del Fante C, Scudeller L, Mortellaro C, Viarengo G, Martinasso A, Perotti C. Automated mononuclear cell collection: a feasibility study employing a new software for extracorporeal photopheresis. Vox Sang 2019; 114:884-889. [PMID: 31463961 DOI: 10.1111/vox.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Very recently, Fresenius Kabi, improved the software (autoMNC lymphocytes, SW 04.03.08) for mononuclear cells (MNCs) collection with the aim to ameliorate the quality of harvest, employing the automated autoMNC lymphocytes software SW 04.03.09. Herein, we report the results of an observational study evaluating the feasibility of MNCs collection in patients undergoing extracorporeal photopheresis (ECP) at our centre, using the new COM.TEC software 04.03.08c for MNC collection, afterwards integrated in the software 04.03.09, available on the market since November 2018. MATERIALS AND METHODS Thirty adult patients (21 males and 9 females) with GvHD, Chronic Lung Allograft Dysfunction or renal rejection, were consecutively enrolled to undergo 1 ECP procedure by the offline technique, according to our internal protocol, processing 1·5 blood volumes. Feasibility of collection was defined as: Hct in collection bag ≤5%, MNCs purity (percentage of MNCs/bag) ≥80%, MNCs collection efficiency (CE2) ≥60%, patient's platelet depletion ≤50%. RESULTS Thirty ECP procedures were evaluated. Feasibility (defined by the four parameters previously described) of MNCs collection was observed in 1 out of the 30 harvests analysed. Median Hct in the product was 3·45% (IQR: 2·6-5·0), and median MNCs purity was 97·2% (IQR 89·1-98·6). Median CE2 for MNCs was 21·4% (IQR: 11·9-41·2), and median patient's platelet depletion was 36·2% (IQR 21·9-51·4). CONCLUSION The autoMNC lymphocytes software SW 04.03.08c for MNCs collection in ECP setting demonstrated to collect a good quality product in terms of purity and RBC contamination even if the collection efficiency and platelet contamination must be improved.
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Affiliation(s)
- Claudia Del Fante
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigia Scudeller
- Scientific Direction, Clinical Epidemiology and Biostatistics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Mortellaro
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Viarengo
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Martinasso
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Perotti
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Tuazon SA, Li A, Gooley T, Eunson TW, Maloney DG, Turtle CJ, Linenberger ML, Connelly-Smith LS. Factors affecting lymphocyte collection efficiency for the manufacture of chimeric antigen receptor T cells in adults with B-cell malignancies. Transfusion 2019; 59:1773-1780. [PMID: 30729531 DOI: 10.1111/trf.15178] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical and procedural parameters that affect the optimal collection of lymphocytes for the production of chimeric antigen receptor (CAR) T cells remain undefined but are increasingly important, as commercial products are now available. We evaluated determinants of low lymphocyte collection efficiency (CE) and the rate of successful CAR T-cell manufacture in middle-aged and older adults with advanced B-cell malignancies. STUDY DESIGNS AND METHODS Mononuclear cell collections using two apheresis platforms (COBE Spectra and Spectra Optia, Terumo BCT) from patients participating in a CD19-directed CAR T-cell therapy trial were reviewed. Patient- and disease-specific factors, peripheral blood counts, apheresis parameters, and product cell counts were analyzed to determine effects on lymphocyte CE. RESULTS Ninety-two apheresis events from patients with acute lymphocytic leukemia (ALL) (n = 28), chronic lymphocytic leukemia (n = 18), and non-Hodgkin lymphoma (n = 46) were available for analysis. Forty-one collections (45%) had a lymphocyte CE of <40%. On multivariable analysis, age (every 10-year increase, odds ratio [OR] = 1.51; p = 0.034), disease type (chronic lymphocytic leukemia vs. ALL, OR = 0.24; p = 0.052; non-Hodgkin lymphoma vs. ALL, OR = 0.20; p = 0.009) and precollection platelets (every 10 × 103 /μL increase, OR = 1.07; p = 0.005) were appreciably associated with a lymphocyte CE of <40%. No major apheresis complications occurred. CONCLUSIONS Lymphocyte collection at our center was well tolerated and 100% successful in manufacturing CD19-directed CAR T cells from adult patients with B-cell malignancies despite low CE in some patients. A diagnosis of ALL, advancing age, and higher preapheresis platelet counts were observed to be associated with low CE.
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Affiliation(s)
- Sherilyn A Tuazon
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Ang Li
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
| | - Theodore Gooley
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Thomas W Eunson
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - David G Maloney
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Cameron J Turtle
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael L Linenberger
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
| | - Laura S Connelly-Smith
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
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11
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Ceppi F, Rivers J, Annesley C, Pinto N, Park JR, Lindgren C, Mgebroff S, Linn N, Delaney M, Gardner RA. Lymphocyte apheresis for chimeric antigen receptor T-cell manufacturing in children and young adults with leukemia and neuroblastoma. Transfusion 2018. [PMID: 29536556 DOI: 10.1111/trf.14569] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The first step in the production of chimeric antigen receptor T cells is the collection of autologous T cells using apheresis technology. The procedure is technically challenging, because patients often have low leukocyte counts and are heavily pretreated with multiple lines of chemotherapy, marrow transplantation, and/or radiotherapy. Here, we report our experience of collecting T lymphocytes for chimeric antigen receptor T-cell manufacturing in pediatric and young adult patients with leukemia, non-Hodgkin lymphoma, or neuroblastoma. STUDY DESIGN AND METHODS Apheresis procedures were performed on a COBE Spectra machine using the mononuclear cell program, with a collection target of 1 × 109 total mononuclear cells per kilogram. Data were collected regarding preapheresis and postapheresis blood counts, apheresis parameters, products, and adverse events. RESULTS Ninety-nine patients (ages 1.3-25.7 years) and 102 apheresis events were available for analysis. Patients underwent apheresis at a variety of absolute lymphocyte cell counts, with a median absolute lymphocyte count of 944 cells/μL (range, 142-6944 cells/μL). Twenty-two patients (21.6%) had absolute lymphocyte counts less than 500 cells/μL. The mononuclear cell target was obtained in 100% of all apheresis harvests, and chimeric antigen receptor T-cell production was possible from the majority of collections (94%). Mononuclear cell collection efficiency was 65.4%, and T-lymphocyte collection efficiency was 83.4%. Ten patients (9.8%) presented with minor adverse events during the 102 apheresis procedures, with one exception of a severe allergy. CONCLUSIONS Mononuclear cell apheresis for chimeric antigen receptor T-cell therapy is well tolerated and safe, and it is possible to obtain an adequate quantity of CD3+ lymphocytes for chimeric antigen receptor T-cell manufacturing in heavily pretreated patients who have low lymphocyte counts.
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Affiliation(s)
- Francesco Ceppi
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Pediatric Hematology-Oncology Research Laboratory & Pediatric Hematology-Oncology Unit, Division of Pediatrics, Department Woman-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Julie Rivers
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Bloodworks NW, Seattle, Washington
| | - Colleen Annesley
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Bloodworks NW, Seattle, Washington
| | - Navin Pinto
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Bloodworks NW, Seattle, Washington
| | - Julie R Park
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Bloodworks NW, Seattle, Washington
| | - Catherine Lindgren
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Bloodworks NW, Seattle, Washington
| | - Stephanie Mgebroff
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Bloodworks NW, Seattle, Washington
| | - Naomi Linn
- Apheresis Department, Bloodworks NW, Seattle, Washington
| | - Meghan Delaney
- Children's National Health System, Washington, DC.,Department of Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Rebecca A Gardner
- Center for Clinical and Translational Research, Seattle Children's Hospital and Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Bloodworks NW, Seattle, Washington
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