Beyond Chemotherapy: Checkpoint Inhibition and Cell-Based Therapy in Non-Hodgkin Lymphoma

Immunotherapy approaches for hematological cancers

Hematological cancers such as leukemia, lymphoma, and multiple myeloma have traditionally been treated with chemo and radiotherapy approaches. Introduction of immunotherapies for treatment of these diseases has led to patient remissions that would not have been possible with traditional approaches. In this critical review we identify main disease characteristics, symptoms, and current treatment options. Five common immunotherapies, namely checkpoint inhibitors, vaccines, cell-based therapies, antibodies, and oncolytic viruses, are described, and their applications in hematological cancers are critically discussed.

Enhanced systemic antilymphoma immune response by photothermal therapy with CpG deoxynucleotide coated nanoparticles

We investigated a novel mechanism of in situ vaccination in a lymphoma model. Radiation (RT) can induce abscopal responses in pre-clinical lymphoma models but has not translated to clinical efficacy. We hypothesized that immune stimulation with CpG deoxynucleotides could enhance abscopal effects induced by radiation or by photothermal therapy (PTT), which has been shown to have an immune stimulatory effect in solid tumors but has not been studied in lymphoma. Here, we designed a branched gold nanoparticle (BNP) platform to carry CpGs while maintaining PTT function and compared the immunologic profile of the tumor microenvironment after PTT or RT in a dual flank lymphoma model. One flank was treated with CpG with RT or CpG with PTT and the other tumor was left untreated. We found that the CpG/PTT groups had significant reduction in growth in both treated (primary) and untreated (secondary) tumors suggesting an improved abscopal response, with a concomitant increase in CD8/CD4 ratio and cytotoxic T cell/regulatory T cell ratio in both the primary and secondary tumor compared with CpG/RT. Dendritic cells in the primary and secondary draining lymph nodes had increased maturation markers in the CpG/PTT group, and the effector memory T cells (both CD4 and CD8) in the secondary tumor and the spleen were increased, suggesting a systemic vaccination effect. These data suggest that in a lymphoma model, PTT using a CpG nanoparticle platform resulted in enhanced in situ vaccination and abscopal response compared with RT.

Tri-ethylene glycol modified class B and class C CpG conjugated gold nanoparticles for the treatment of lymphoma

CpG oligodeoxynucleotides (CpGs) can induce an anti-tumor immune response, but also uniquely cause direct lymphoma cytotoxicity. To improve the delivery and efficacy of CpGs, we utilized a tri-ethylene modified CpG conjugated gold nanoparticle (tmCpG NP) platform that is compatible with both class B and class C CpGs, to treat various types of lymphoma, including diffuse large B cell lymphoma, high-grade lymphoma, Burkitt's lymphoma, and mantle cell lymphoma. Both classes of tmCpG NPs reduced viability of human and murine lymphoma cells via apoptosis compared with free CpGs, while having no toxic effects on dendritic cells. TmCpG NPs increased CD19, CD20, and OX40 expression on the lymphoma cells. Overall, we introduced a stable tmCpG NP design that has significant anti-lymphoma effects.

Chimeric Antigen Receptor-Engineered T-Cells - A New Way and Era for Lymphoma Treatment

BACKGROUND

Patients with refractory or relapsed diffuse large B-cell lymphoma have a poor prognosis with the current standard of care.

OBJECTIVE

Chimeric Antigen Receptor T-cells (CAR T-cells) are functionally reprogrammed lymphocytes, which are able to recognize and kill tumor cells. The aim of this study is to make progress in this area.

METHODS

A mini-review was achieved using the articles published in Web of Science and PubMed in the last year and the new patents were made in this field.

RESULTS

The responses to CAR T-cell products axicabtagene ciloleucel and tisagenlecleucel are promising; the objective response rate can reach up to 83%, and the complete response rate ranges between 40 and 58%. About half of the patients may have serious side effects, such as cytokine release syndrome and neurotoxicity. Current and future developments include the improvement of CAR T-cell expansion and polyfunctionality, the combined use of CAR T-cells with a fusion protein between interferon and an anti-CD20 monoclonal antibody, with checkpoint inhibitors or small molecule sensitizers that have apoptotic-regulatory effects. Furthermore, the use of IL-12-expressing CAR T-cells, an improved technology for the production of CAR T-cells based on targeted nucleases, the widespread use of allogeneic CAR T-cells or universal CAR T-cells obtained from genetically engineered healthy donor T-cells are future developments actively considered.

CONCLUSION

CAR T-cell therapy significantly improved the outcome of patients with relapsed or refractory diffuse large B-cell lymphoma. The advances in CAR T-cells production technology will improve the results and enable the expansion of this new immunotherapy.

Diagnosis and Management of Immune Related Adverse Events (irAEs) in Cancer Immunotherapy

Immune checkpoint inhibitors (ICPIs) and chimeric antigen receptor (CAR) T-cell therapy are two main promising methods of immunotherapy, which have become increasingly important in cancer treatment. After the wider application of these medicine in clinic, a range of immune related adverse events (irAEs) covering almost any system arouse the concern for being randomness and unpredictability. Even if most adverse events are mild and controllable after thoughtful management, the occurrence of life-threatening toxicities should not be ignored because of the insidious and atypical symptoms, which makes the early diagnosis even more challenging. In this review, a brief introduction of immunotherapy and mechanisms underlying irAEs is involved. We mainly focus on the early diagnostic method and recommended management of toxicities of different systems separately, and consequently maximized effectiveness of immunotherapy can be achieved.