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Deveci B, Saba R. Prolonged viral positivity induced recurrent coronavirus disease 2019 (COVID-19) pneumonia in patients receiving anti-CD20 monoclonal antibody treatment: Case reports. Medicine (Baltimore) 2021; 100:e28470. [PMID: 34967391 PMCID: PMC8718200 DOI: 10.1097/md.0000000000028470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The outbreak of novel coronavirus (severe acute respiratory syndrome coronavirus 2), which causes the coronavirus disease 2019 (COVID-19), is the most important current health problem. The number of patients is increasing worldwide. Pneumonia is the most life-threatening complication of the disease. Prolonged viral shedding in hematological patients with COVID-19 has been demonstrated; however, data on COVID-19 patients receiving anti-CD20 monoclonal antibody therapy are limited. Accordingly, focusing on humoral immunity, herein, we present 4 COVID-19 patients who were on anti-CD20 monoclonal antibody treatment and had prolonged pneumonia. PATIENT CONCERNS Two of 4 patients were on rituximab and the other 2 were on obinutuzumab therapy. DIAGNOSIS The polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 were positive for all 4 patients and their COVID pneumonia lasted for >50 days. INTERVENTIONS Although all patients were treated with an adequate amount of convalescent plasma, prolonged polymerase chain reaction positivity and prolonged pneumonia were possibly due to the lack of ability of the immune system to initiate its antibody response. OUTCOMES Despite the administration of standard therapies, recurrent pneumonia observed in the present case series of non-neutropenic patients, in whom primary malignancies were under control. CONCLUSIONS It is suggested that further investigations should be performed to understand the underlying pathophysiology.
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Affiliation(s)
- Burak Deveci
- Medstar Antalya Hospital, Hematology and Stem Cell Transplantation Unit, Antalya, Turkey
| | - Rabin Saba
- Medstar Antalya Hospital, Infectious Disease Unit, Antalya, Turkey
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Engelberts PJ, Hiemstra IH, de Jong B, Schuurhuis DH, Meesters J, Beltran Hernandez I, Oostindie SC, Neijssen J, van den Brink EN, Horbach GJ, Verploegen S, Labrijn AF, Salcedo T, Schuurman J, Parren PWHI, Breij ECW. DuoBody-CD3xCD20 induces potent T-cell-mediated killing of malignant B cells in preclinical models and provides opportunities for subcutaneous dosing. EBioMedicine 2020; 52:102625. [PMID: 31981978 PMCID: PMC6992935 DOI: 10.1016/j.ebiom.2019.102625] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/22/2022] Open
Abstract
Background DuoBody®-CD3xCD20 (GEN3013) is a full-length human IgG1 bispecific antibody (bsAb) recognizing CD3 and CD20, generated by controlled Fab-arm exchange. Its Fc domain was silenced by introduction of mutations L234F L235E D265A. Methods T-cell activation and T-cell-mediated cytotoxicity were measured by flow cytometry following co-culture with tumour cells. Anti-tumour activity of DuoBody-CD3xCD20 was assessed in humanized mouse models in vivo. Non-clinical safety studies were performed in cynomolgus monkeys. Findings DuoBody-CD3xCD20 induced highly potent T-cell activation and T-cell-mediated cytotoxicity towards malignant B cells in vitro. Comparison of DuoBody-CD3xCD20 to CD3 bsAb targeting alternative B-cell antigens, or to CD3xCD20 bsAb generated using alternative CD20 Ab, emphasized its exceptional potency. In vitro comparison with other CD3xCD20 bsAb in clinical development showed that DuoBody-CD3xCD20 was significantly more potent than three other bsAb with single CD3 and CD20 binding regions and equally potent as a bsAb with a single CD3 and two CD20 binding regions. DuoBody-CD3xCD20 showed promising anti-tumour activity in vivo, also in the presence of excess levels of a CD20 Ab that competes for binding. In cynomolgus monkeys, DuoBody-CD3xCD20 demonstrated profound and long-lasting B-cell depletion from peripheral blood and lymphoid organs, which was comparable after subcutaneous and intravenous administration. Peak plasma levels of DuoBody-CD3xCD20 were lower and delayed after subcutaneous administration, which was associated with a reduction in plasma cytokine levels compared to intravenous administration, while bioavailability was comparable. Interpretation Based on these preclinical studies, a clinical trial was initiated to assess the clinical safety of subcutaneous DuoBody-CD3xCD20 in patients with B-cell malignancies. Funding Genmab
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MESH Headings
- Animals
- Antibodies, Bispecific/genetics
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/pharmacology
- Antibody Specificity/immunology
- Antibody-Dependent Cell Cytotoxicity
- Antigens, CD20/metabolism
- Antineoplastic Agents, Immunological/pharmacology
- CD3 Complex/metabolism
- Cell Line, Tumor
- Cytotoxicity, Immunologic
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Female
- Humans
- Leukemia, B-Cell/drug therapy
- Leukemia, B-Cell/etiology
- Leukemia, B-Cell/pathology
- Lymphocyte Activation/immunology
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/etiology
- Lymphoma, B-Cell/pathology
- Macaca fascicularis
- Mice
- Mutation
- Recombinant Proteins
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Xenograft Model Antitumor Assays
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Affiliation(s)
| | | | | | | | | | | | - Simone C Oostindie
- Genmab, Utrecht, The Netherlands; Dept of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | - Paul W H I Parren
- Genmab, Utrecht, The Netherlands; Dept of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Pereira DS, Guevara CI, Jin L, Mbong N, Verlinsky A, Hsu SJ, Aviña H, Karki S, Abad JD, Yang P, Moon SJ, Malik F, Choi MY, An Z, Morrison K, Challita-Eid PM, Doñate F, Joseph IBJ, Kipps TJ, Dick JE, Stover DR. AGS67E, an Anti-CD37 Monomethyl Auristatin E Antibody-Drug Conjugate as a Potential Therapeutic for B/T-Cell Malignancies and AML: A New Role for CD37 in AML. Mol Cancer Ther 2015; 14:1650-60. [PMID: 25934707 DOI: 10.1158/1535-7163.mct-15-0067] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/23/2015] [Indexed: 01/22/2023]
Abstract
CD37 is a tetraspanin expressed on malignant B cells. Recently, CD37 has gained interest as a therapeutic target. We developed AGS67E, an antibody-drug conjugate that targets CD37 for the potential treatment of B/T-cell malignancies. It is a fully human monoclonal IgG2 antibody (AGS67C) conjugated, via a protease-cleavable linker, to the microtubule-disrupting agent monomethyl auristatin E (MMAE). AGS67E induces potent cytotoxicity, apoptosis, and cell-cycle alterations in many non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) cell lines and patient-derived samples in vitro. It also shows potent antitumor activity in NHL and CLL xenografts, including Rituxan-refractory models. During profiling studies to confirm the reported expression of CD37 in normal tissues and B-cell malignancies, we made the novel discovery that the CD37 protein was expressed in T-cell lymphomas and in AML. AGS67E bound to >80% of NHL and T-cell lymphomas, 100% of CLL and 100% of AML patient-derived samples, including CD34(+)CD38(-) leukemic stem cells. It also induced cytotoxicity, apoptosis, and cell-cycle alterations in AML cell lines and antitumor efficacy in orthotopic AML xenografts. Taken together, this study shows not only that AGS67E may serve as a potential therapeutic for B/T-cell malignancies, but it also demonstrates, for the first time, that CD37 is well expressed and a potential drug target in AML.
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Affiliation(s)
- Daniel S Pereira
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California.
| | - Claudia I Guevara
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Liqing Jin
- Princess Margaret Cancer Centre, University Health Network, and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Mbong
- Princess Margaret Cancer Centre, University Health Network, and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Alla Verlinsky
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Ssucheng J Hsu
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Hector Aviña
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Sher Karki
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Joseph D Abad
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Peng Yang
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Sung-Ju Moon
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Faisal Malik
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Michael Y Choi
- Division of Hematology-Oncology, University of California, San Diego, Moores Cancer Center, La Jolla, California
| | - Zili An
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Kendall Morrison
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Pia M Challita-Eid
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Fernando Doñate
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Ingrid B J Joseph
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
| | - Thomas J Kipps
- Division of Hematology-Oncology, University of California, San Diego, Moores Cancer Center, La Jolla, California
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network, and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David R Stover
- Agensys Inc., an Affiliate of Astellas Pharma Inc., Santa Monica, California
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Cerquozzi S, Owen C. Clinical role of obinutuzumab in the treatment of naive patients with chronic lymphocytic leukemia. Biologics 2015; 9:13-22. [PMID: 25733804 PMCID: PMC4337412 DOI: 10.2147/btt.s61600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The introduction of targeted therapy against CD20+ with the monoclonal antibody rituximab has dramatically improved the survival of B-cell non-Hodgkin lymphoma including chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma. Unfortunately, CLL remains incurable with chemoimmunotherapy, with many patients having refractory or relapsing disease after rituximab-containing therapy. Obinutuzumab (GA101) is a novel humanized Type II anti-CD20 monoclonal antibody that has been investigated and compared to rituximab. Here, we provide an overview of obinutuzumab, including its mechanisms of action, preclinical data, and Phase I to III clinical studies. Preclinical data illustrate obinutuzumab’s higher potency compared to rituximab through antibody-dependent cellular cytotoxicity and direct cell death. Recently, the CLL11 study presented a significant benefit from obinutuzumab chemoimmunotherapy and supports its use for treatment-naive unfit CLL patients. Herein, we review that obinutuzumab is both a safe and effective alternative to rituximab.
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Affiliation(s)
- Sonia Cerquozzi
- Department of Hematology, University of Calgary, Calgary, AB, Canada
| | - Carolyn Owen
- Department of Hematology, Tom Baker Cancer Centre, Calgary, AB, Canada
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