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Doberschuetz N, Soerensen J, Bonig H, Willasch A, Rettinger E, Pfirrmann V, Salzmann-Manrique E, Schäfer R, Klingebiel T, Bader P, Jarisch A. Mobilized peripheral blood stem cell apheresis via Hickman catheter in pediatric patients. Transfusion 2019; 59:1061-1068. [PMID: 30610749 DOI: 10.1111/trf.15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autologous stem cell transplantation remains an integral treatment tool for certain childhood malignancies. In children, a central venous catheter is typically necessary to provide adequate flow rates for preparative apheresis. In this study, the feasibility and efficiency of collecting CD34+ cells via an indwelling Hickman catheter, preimplanted for chemotherapy, instead of placing an additional temporary central venous catheter was evaluated. STUDY DESIGN AND METHODS Forty-eight pediatric leukaphereses for autologous hematopoietic stem cell transplantation using Spectra Optia MNC, Version 3.0 were reviewed. We compared preimplanted Hickman catheters with a temporary Shaldon catheter, inserted for apheresis. Apheresis was considered successful if a dose of 2 × 106 CD34+ peripheral blood stem cells/kg BW was achieved. RESULTS In 43 (89.6%) of the 48 patients, a Hickman catheter was used for leukapheresis. Only 5 patients (10.4%) received a temporary Shaldon catheter. In both groups, apheresis was performed without apparent adverse reactions. The dose of collected CD34+ peripheral blood stem cells was 12.7 × 106 (range, 2.3-70.7 × 106 ) cells/kg BW in the Hickman group and 16.2 × 106 (range, 3.8-48.4 × 106 ) cells/kg BW in the Shaldon group, showing no statistically significant difference (p = 0.58). In both groups, the primary endpoint of a minimal CD34+ cell concentration of 2 × 106 cells/kg BW was achieved at a maximum of two leukapheresis sessions. Apheresis efficacy was further confirmed by the collection efficiency of 40.2% in the Hickman group and 27.8% in the Shaldon group (p = 0.32). CONCLUSION These data indicate the reliable feasibility and efficacy of mobilized apheresis via an indwelling Hickman catheter. In light of this, the routine insertion of a dialysis catheter for the purpose of leukapheresis should be critically reconsidered.
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Affiliation(s)
- Nora Doberschuetz
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany.,Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Andre Willasch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Verena Pfirrmann
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Richard Schäfer
- Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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Bakhtiar S, Salzmann-Manrique E, Hutter M, Krenn T, Duerken M, Faber J, Reinhard H, Kreyenberg H, Huenecke S, Cappel C, Bremm M, Pfirrmann V, Merker M, Barnbrock A, Schöning S, Willasch AM, Rettinger E, Soerensen J, Klingebiel TE, Jarisch A, Bader P. AlloHSCT in paediatric ALL and AML in complete remission: improvement over time impacted by accreditation? Bone Marrow Transplant 2018; 54:737-745. [PMID: 30258130 DOI: 10.1038/s41409-018-0341-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 01/10/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) has become a well-established treatment option for many patients suffering from malignant and non-malignant diseases. In the past decade, high-resolution HLA-typing, remission surveillance, pre-emptive immune intervention, and standardisation in supportive care measures have substantially improved transplant outcomes. This retrospective study evaluated transplant procedures in 162 paediatric patients with acute lymphoblastic leukaemia (n = 124) or acute myeloid leukaemia (n = 38) who received their first alloHSCT in our institution over an 11-year period. We observed a significant reduction in risk of non-relapse mortality (NRM) over time (HR = 0.34, 95% CI 0.12-0.98; P = 0.05), the 4-year NRM estimate decreased from 20% in 2005-2008 to 7% in 2012-2016 (P = 0.02) and an increase in survival after relapse. There was no significant difference in patients who received a graft from a sibling, haplo, or an unrelated donor with regard to their overall survival (P = 0.45), event-free survival (P = 0.61), and non-relapse mortality (P = 0.19). Our data suggest that a specific transplant infrastructure with a highly experienced team in an accredited transplant centre likely contributes to better transplant outcomes for acute leukaemia patients in complete remission regardless of donor type.
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Affiliation(s)
- Shahrzad Bakhtiar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Emilia Salzmann-Manrique
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Martin Hutter
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Thomas Krenn
- Paediatric Haematology and Oncology, University of Saarland, Homburg/Saar, Germany
| | - Matthias Duerken
- Department of Paediatric Oncology, University of Mannheim, Mannheim, Germany
| | - Joerg Faber
- Department of Paediatric Haematology and Oncology, Children's Hospital of Johannes Gutenberg University, Mainz, Germany
| | - Harald Reinhard
- Asklepios Kinderklinik Sankt Augustin Arnold-Janssen-Straße 29, 53757, St. Augustin, Germany
| | - Hermann Kreyenberg
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Claudia Cappel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Melanie Bremm
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Verena Pfirrmann
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Michael Merker
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Anke Barnbrock
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Stefan Schöning
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Andre Manfred Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Jan Soerensen
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Thomas Erich Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Andrea Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.
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Huenecke S, Cappel C, Esser R, Pfirrmann V, Salzmann-Manrique E, Betz S, Keitl E, Banisharif-Dehkordi J, Bakhtiar S, Königs C, Jarisch A, Soerensen J, Ullrich E, Klingebiel T, Bader P, Bremm M. Development of Three Different NK Cell Subpopulations during Immune Reconstitution after Pediatric Allogeneic Hematopoietic Stem Cell Transplantation: Prognostic Markers in GvHD and Viral Infections. Front Immunol 2017; 8:109. [PMID: 28239380 PMCID: PMC5300968 DOI: 10.3389/fimmu.2017.00109] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/23/2017] [Indexed: 02/03/2023] Open
Abstract
Natural killer (NK) cells play an important role following allogeneic hematopoietic stem cell transplantation (HSCT) exerting graft-versus-leukemia/tumor effect and mediating pathogen-specific immunity. Although NK cells are the first donor-derived lymphocytes reconstituting post-HSCT, their distribution of CD56++CD16- (CD56bright), CD56++CD16+ (CD56intermediate=int), and CD56+CD16++ (CD56dim) NK cells is explicitly divergent from healthy adults, but to some extent comparable to the NK cell development in early childhood. The proportion of CD56bright/CD56int/CD56dim changed from 15/8/78% in early childhood to 6/4/90% in adults, respectively. Within this study, we first compared the NK cell reconstitution post-HSCT to reference values of NK cell subpopulations of healthy children. Afterward, we investigated the reconstitution of NK cell subpopulations post-HSCT in correlation to acute graft versus host disease (aGvHD) and chronic graft versus host disease (cGvHD) as well as to viral infections. Interestingly, after a HSCT follow-up phase of 12 months, the distribution of NK cell subpopulations largely matched the 50th percentile of the reference range for healthy individuals. Patients suffering from aGvHD and cGvHD showed a delayed reconstitution of NK cells. Remarkably, within the first 2 months post-HSCT, patients suffering from aGvHD had significantly lower levels of CD56bright NK cells compared to patients without viral infection or without graft versus host disease (GvHD). Therefore, the amount of CD56bright NK cells might serve as an early prognostic factor for GvHD development. Furthermore, a prolonged and elevated peak in CD56int NK cells seemed to be characteristic for the chronification of GvHD. In context of viral infection, a slightly lower CD56 and CD16 receptor expression followed by a considerable reduction in the absolute CD56dim NK cell numbers combined with reoccurrence of CD56int NK cells was observed. Our results suggest that a precise analysis of the reconstitution of NK cell subpopulations post-HSCT might indicate the occurrence of undesired events post-HSCT such as severe aGvHD.
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Affiliation(s)
- Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Ruth Esser
- GMP Development Unit, Hannover Medical School, Institute of Cellular Therapeutics , Hannover , Germany
| | - Verena Pfirrmann
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | | | - Sibille Betz
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Eileen Keitl
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | | | - Shahrzad Bakhtiar
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Christoph Königs
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Andrea Jarisch
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Evelyn Ullrich
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt, Germany; LOEWE Center for Cell and Gene Therapy, Goethe University, Frankfurt, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
| | - Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital , Frankfurt , Germany
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Cappel C, Huenecke S, Suemmerer A, Erben S, Rettinger E, Pfirrmann V, Heinze A, Zimmermann O, Klingebiel T, Ullrich E, Bader P, Bremm M. Cytotoxic potential of IL-15-activated cytokine-induced killer cells against human neuroblastoma cells. Pediatr Blood Cancer 2016; 63:2230-2239. [PMID: 27433920 DOI: 10.1002/pbc.26147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/27/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neuroblastoma (NB) is the most common solid extracranial tumor in childhood. Despite advances in therapy, the prognosis is poor and optimized therapies are urgently needed. Therefore, we investigated the antitumor potential of interleukin-15 (IL-15)-activated cytokine-induced killer (CIK) cells against different NB cell lines. PROCEDURE CIK cells were generated from peripheral blood mononuclear cells by the stimulation with interferon-γ (IFN-γ), IL-2, OKT-3 and IL-15 over a period of 10-12 days. The cytotoxic activity against NB cells was analyzed by nonradioactive Europium release assay before and after blocking of different receptor-ligand interactions relevant in CIK cell-mediated cytotoxicity. RESULTS The final CIK cell products consisted in median of 83% (range: 75.9-91.9%) CD3+ CD56- T cells, 14% (range: 5.2-20.7%) CD3+ CD56+ NK-like T cells and 2% (range: 0.9-4.8%) CD3- CD56+ NK cells. CIK cells expanded significantly upon ex vivo stimulation with median rates of 22.3-fold for T cells, 58.3-fold for NK-like T cells and 2.5-fold for NK cells. Interestingly, CD25 surface expression increased from less than equal to 1% up to median 79.7%. Cytotoxic activity of CIK cells against NB cells was in median 34.7, 25.9 and 34.8% against the cell lines UKF-NB-3, UKF-NB-4 and SK-N-SH, respectively. In comparison with IL-2-stimulated NK cells, CIK cells showed a significantly higher cytotoxicity. Antibody-mediated blocking of the receptors NKG2D, TRAIL, FasL, DNAM-1, NKp30 and lymphocyte function-associated antigen-1 (LFA-1) significantly reduced lytic activity, indicating that diverse cytotoxic mechanisms might be involved in CIK cell-mediated NB killing. CONCLUSIONS Unlike the mechanism reported in other malignancies, NKG2D-mediated cytotoxicity does not constitute the major killing mechanism of CIK cells against NB.
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Affiliation(s)
- Claudia Cappel
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
| | - Anica Suemmerer
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Stephanie Erben
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Verena Pfirrmann
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Annekathrin Heinze
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Olga Zimmermann
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Evelyn Ullrich
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Melanie Bremm
- Department for Stem Cell Transplantation and Immunology, Clinic for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
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Bremm M, Huenecke S, Zimmermann O, Pfirrmann V, Quaiser A, Bonig H, Soerensen J, Klingebiel T, Rettinger E, Bader P, Cappel C. In-vitro influence of mycophenolate mofetil (MMF) and Ciclosporin A (CsA) on cytokine induced killer (CIK) cell immunotherapy. J Transl Med 2016; 14:264. [PMID: 27620209 PMCID: PMC5020454 DOI: 10.1186/s12967-016-1024-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/30/2016] [Indexed: 01/10/2023] Open
Abstract
Background Cytokine-induced-killer (CIK) cells are a promising immunotherapeutic approach for impending relapse following hematopoietic stem cell transplantation (HSCT). However, there is a high risk for treatment failure associated with severe graft versus host disease (GvHD) necessitating pharmaceutical intervention post-transplant. Whether immunosuppression with mycophenolate mofetil (MMF) or Ciclosporin A (CsA) influences the cytotoxic effect of CIK cell immunotherapy is still an open issue. Methods CIK cells were generated from PBMC as previously described followed by co-incubation with mycophenolic acid (MPA) or CsA. Proliferation, cytotoxicity and receptor expression were investigated following short- (24 h), intermediate- (3 days) and long-term (7 days) MPA incubation with the intention to simulate the in vivo situation when CIK cells were given to a patient with relevant MPA/CsA plasma levels. Results Short-term MPA treatment led to unchanged proliferation capacity and barely had any effect on viability and cytotoxic capability in vitro. The composition of CIK cells with respect to T-, NK-like T- and NK cells remained stable. Intermediate MPA treatment lacked effects on NKG2D, FasL and TRAIL receptor expression, while an influence on proliferation and viability was detectable. Furthermore, long-term treatment significantly impaired proliferation, restricted viability and drastically reduced migration-relevant receptors accompanied by an alteration in the CD4/CD8 ratio. CD3+CD56+ cells upregulated receptors relevant for CIK cell killing and migration, whereas T cells showed the most interference through significant reductions in receptor expression. Interestingly, CsA treatment had no significant influence on CIK cell viability and the cytotoxic potential against K562. Conclusions Our data indicate that if immunosuppressant therapy is indispensable, efficacy of CIK cells is maintained at least short-term, although more frequent dosing might be necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1024-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
| | - Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Olga Zimmermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Verena Pfirrmann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Andrea Quaiser
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Halvard Bonig
- Division for Translational Development of Cellular Therapeutics, Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany.,German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Eva Rettinger
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
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Oelsner S, Wagner J, Friede ME, Pfirrmann V, Genßler S, Rettinger E, Buchholz CJ, Pfeifer H, Schubert R, Ottmann OG, Ullrich E, Bader P, Wels WS. Chimeric antigen receptor-engineered cytokine-induced killer cells overcome treatment resistance of pre-B-cell acute lymphoblastic leukemia and enhance survival. Int J Cancer 2016; 139:1799-809. [DOI: 10.1002/ijc.30217] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/24/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Oelsner
- Georg-Speyer-Haus; Institute for Tumor Biology and Experimental Therapy; Frankfurt Germany
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
| | - Juliane Wagner
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
- LOEWE Center for Cell and Gene Therapy; Goethe University; Frankfurt Germany
| | - Miriam E. Friede
- Georg-Speyer-Haus; Institute for Tumor Biology and Experimental Therapy; Frankfurt Germany
| | - Verena Pfirrmann
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
| | - Sabrina Genßler
- Georg-Speyer-Haus; Institute for Tumor Biology and Experimental Therapy; Frankfurt Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
| | - Christian J. Buchholz
- Molecular Biotechnology and Gene Therapy; Paul-Ehrlich-Institut; Langen Germany
- German Cancer Consortium (DKTK); Heidelberg Germany
| | - Heike Pfeifer
- Department of Medicine, Hematology and Oncology; Goethe University; Frankfurt Germany
| | - Ralf Schubert
- Division for Allergology, Pneumology and Cystic Fibrosis; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
| | - Oliver G. Ottmann
- Department of Haematology, Division of Cancer and Genetics; Cardiff University School of Medicine; Cardiff United Kingdom
| | - Evelyn Ullrich
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
- LOEWE Center for Cell and Gene Therapy; Goethe University; Frankfurt Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology; Hospital for Children and Adolescents, Goethe University; Frankfurt Germany
| | - Winfried S. Wels
- Georg-Speyer-Haus; Institute for Tumor Biology and Experimental Therapy; Frankfurt Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz; Germany
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Oelsner S, Wagner J, Friede ME, Pfirrmann V, Rettinger E, Schubert R, Pfeifer H, Ullrich E, Bader P, Wels WS. Abstract A164: Genetically modified cytokine-induced killer (CIK) cells for targeted cancer therapy. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6074.cricimteatiaacr15-a164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Pre-emptive immunotherapy after HSC transplantation based on minimal residual disease (MRD) status with donor lymphocyte infusions (DLI) using cytokine-induced killer (CIK) cells may be beneficial to prevent relapse with a reduced risk of causing graft-versus-host-disease (GvHD) compared to conventional T cell infusion. CIK cells are a heterogeneous effector cell population including T cells (CD3+CD56-), natural killer (NK) cells (CD3-CD56+) and natural killer T (T-NK) cells (CD3+CD56+), that exhibit non-MHC-restricted cytotoxic activity and are generated by ex vivo expansion of peripheral blood mononuclear cells (PBMC) through the addition of interferon (IFN)-γ, anti-CD3 antibody, IL-2 and IL-15.
While CIK cells have shown potent in vivo activity against various cancer types such as lymphomas or colorectal cancer, their cytotoxicity against B-ALL, characterized by the expression of CD19, has been limited. Hence, retargeting of CIK cells using chimeric antigen receptors (CARs) to facilitate selective target cell recognition and enhance specific cytotoxicity represents a promising approach. CAR comprise an extracellular scFv antibody fragment as an antigen-binding domain, linked via a flexible hinge region and a transmembrane domain to an intracellular signaling moiety such as CD3 zeta chain (first generation CAR), or zeta chain fused to a co-stimulatory protein domain such as CD28 (second generation CAR).
We established an optimized protocol for transduction of CIK cells with CD19-specific lentiviral CAR constructs, and characterized cells for expression of an EGFP marker gene and CAR surface expression. Effects of exposure to lentiviral vector particles on the development of CIK cell subpopulations were monitored. In in vitro cytotoxicity assays we could demonstrate potent and selective cytotoxicity of retargeted CIK cells towards established cancer cell lines expressing CD19 and primary pre-B-ALL blasts. In addition, we observed significantly enhanced degranulation of CAR-CIK cells upon target cell contact and showed increased secretion of pro-inflammatory cytokines, while no secretion of immunosuppressive IL-10 could be detected. Cytotoxity towards non-malignant allo-PBMCs remained low.
In addition, we investigated anti-leukemic activity of retargeted CIK cells in vivo in NOD/SCID common gamma chain knockout (NSG) mouse models using bioluminescence and fluorescence imaging. We observed potent reduction of tumor load after only two CIK cell applications in mice with an engrafted primary pre-B-ALL yielding long-term survivors with a negative MRD status (4/6). In a separate model, we demonstrated migration of CD19-specific CIK cells into local, subcutaneous tumor sites.
In conclusion, CAR-CIK cells represent a promising alternative to CAR-T cell therapy, as relatively high numbers of conventional CIK cells have already been infused in clinical trials, which demonstrated a low risk of causing severe side effects.
Citation Format: Sarah Oelsner, Juliane Wagner, Miriam E. Friede, Verena Pfirrmann, Eva Rettinger, Ralf Schubert, Heike Pfeifer, Evelyn Ullrich, Peter Bader, Winfried S. Wels. Genetically modified cytokine-induced killer (CIK) cells for targeted cancer therapy. [abstract]. In: Proceedings of the CRI-CIMT-EATI-AACR Inaugural International Cancer Immunotherapy Conference: Translating Science into Survival; September 16-19, 2015; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(1 Suppl):Abstract nr A164.
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Affiliation(s)
- Sarah Oelsner
- 1Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt Am Main, Germany,
| | - Juliane Wagner
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Miriam E. Friede
- 1Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt Am Main, Germany,
| | - Verena Pfirrmann
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Eva Rettinger
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Ralf Schubert
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Heike Pfeifer
- 3Goethe University Frankfurt, Department of Medicine, Hematology and Oncology, Frankfurt Am Main, Germany
| | - Evelyn Ullrich
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Peter Bader
- 2Goethe University Frankfurt, Hospital for Children and Adolescents, Frankfurt Am Main, Germany,
| | - Winfried S. Wels
- 1Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt Am Main, Germany,
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8
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Pfirrmann V, Oelsner S, Rettinger E, Huenecke S, Bonig H, Merker M, Wels WS, Cinatl J, Schubert R, Klingebiel T, Bader P. Cytomegalovirus-specific cytokine-induced killer cells: concurrent targeting of leukemia and cytomegalovirus. Cytotherapy 2015; 17:1139-51. [PMID: 26072027 DOI: 10.1016/j.jcyt.2015.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AIMS Human cytomegalovirus (CMV) infection and reactivation is a leading complication of allogeneic hematopoietic stem cell transplantation (HSCT). In addition to drug treatment, the adoptive transfer of virus-specific T cells to restore cellular immunity has become a standard therapy after allogeneic HSCT. We recently demonstrated potent anti-leukemic activity of interleukin (IL)-15-activated cytokine-induced killer (CIK) cells. With the use of the same expansion protocol, we asked whether concurrent CMV antigen-pulsing might generate CIK cells with anti-leukemic and anti-CMV activity. METHODS CIK cells expanded in the presence of interferon-γ, IL-2, IL-15 and anti-CD3 antibody were pulsed once with CMV(pp65) peptide pool. CMV-specific CIK (CIK(pp65)) and conventional CIK cells were phenotypically and functionally characterized according to their cytokine secretion pattern, degranulation capacity and T-cell receptor (TCR)-mediated and NKG2D-mediated cytotoxicity. RESULTS We demonstrated that among CIK cells generated from CMV-seropositive donors, a single stimulation with CMV(pp65) protein co-expanded cytotoxic CMV-specific cells without sacrificing anti-tumor reactivity. Cells generated in this fashion lysed CMV(pp65)-loaded target cells and CMV-infected fibroblasts but also leukemic cells. Meanwhile, the alloreactive potential of CIK(pp65) cells remained low. Interestingly, CMV reactivity was TCR-mediated and CMV-specific cells could be found in CD3(+)CD8(+)CD56(+/-) cytotoxic T-cell subpopulations. CONCLUSIONS We provide an efficient method to generate CIK(pp65) cells that may represent a useful cell therapy approach for preemptive immunotherapy in patients who have both an apparent risk of CMV and impending leukemic relapse after allogeneic stem cell transplantation.
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Affiliation(s)
- Verena Pfirrmann
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
| | - Sarah Oelsner
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany; Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology and German Red Cross Blood Donor Service, University Hospital Frankfurt, Goethe University, Baden-Wuerttemberg-Hessen, Frankfurt/Main, Germany
| | - Michael Merker
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Winfried S Wels
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt/Main, Germany
| | - Jindrich Cinatl
- Institute for Experimental Cancer Research in Pediatrics, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Ralf Schubert
- Division of Allergology, Pneumology and Cystic Fibrosis, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany.
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9
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Bunos M, Hümmer C, Wingenfeld E, Sorg N, Pfirrmann V, Bader P, Seifried E, Bönig H. Automated isolation of primary antigen-specific T cells from donor lymphocyte concentrates: results of a feasibility exercise. Vox Sang 2015; 109:387-93. [PMID: 25951789 DOI: 10.1111/vox.12291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The safety and clinical efficacy of adoptive transfer of prospectively isolated antigen-specific T cells are well established. Several competing selection methods are available, one of which is based on immunomagnetic enrichment of T cells secreting IFNγ after incubation with the relevant antigen. The proprietary, GMP-conforming selection technology, called 'cytokine capture system' (CCS) is established in many laboratories for the CliniMACS Plus system. It is robust and efficient, but labour-intensive and incompatible with a single-shift working schedule. An automatic immunomagnetic cell processing system, CliniMACS Prodigy ('Prodigy'), including a protocol for fully automatic CCS execution was recently released. MATERIAL AND METHODS Feasibility of clinical-scale CMV-specific T-cell selection using Prodigy was evaluated using leukoapheresis products from five healthy CMV sero-positive volunteers. Clinical reagents and consumables were used throughout. RESULTS The process required no operator input beyond set-up and QC-sample collection, that is, feasibility was given. An IFNγ-secreting target T-cell population was detectable after stimulation, and >2 log-scale relative depletion of not CMV-reactive T cells in the target population was achieved. Purity, that is the frequency of CMV-reactive T cells among all CD3(+) cells ranged between 64 and 93%. CONCLUSION The CCS protocol on Prodigy is unrestrictedly functional. It runs fully automatically beyond set-up and thus markedly reduces labour. The quality of the products generated is similar to products generated with CliniMACS Plus. The automatic system is thus suitable for routine clinical application.
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Affiliation(s)
- M Bunos
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - C Hümmer
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - E Wingenfeld
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - N Sorg
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - V Pfirrmann
- Center of Child and Adolescent Health, Department for Stem Cell Transplantation and Immunology, Goethe University Medical Center, Frankfurt, Germany
| | - P Bader
- Center of Child and Adolescent Health, Department for Stem Cell Transplantation and Immunology, Goethe University Medical Center, Frankfurt, Germany
| | - E Seifried
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - H Bönig
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
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10
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Rettinger E, Glatthaar A, Abhari BA, Oelsner S, Pfirrmann V, Huenecke S, Kuçi S, Kreyenberg H, Willasch AM, Klingebiel T, Fulda S, Bader P. SMAC Mimetic BV6 Enables Sensitization of Resistant Tumor Cells but also Affects Cytokine-Induced Killer (CIK) Cells: A Potential Challenge for Combination Therapy. Front Pediatr 2014; 2:75. [PMID: 25101252 PMCID: PMC4103003 DOI: 10.3389/fped.2014.00075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/03/2014] [Indexed: 01/03/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an established treatment option for high-risk hematological malignancies, and may also be offered to patients with solid malignancies refractory to conventional therapies. In case of patients' relapse, refractory tumor cells may then be targeted by cellular therapy-based combination strategies. Here, we investigated the potential of small molecule IAP (SMAC mimetic) BV6 in increasing cytokine-induced killer (CIK) cell-mediated cytotoxicity against different tumor targets. Four-hour pre-incubation with 2.5 μMol BV6 moderately enhanced CIK cell-mediated lysis of hematological (H9, THP-1, and Tanoue) and solid malignancies (RH1, RH30, and TE671). However, BV6 also increased apoptosis of non-malignant cells like peripheral blood mononuclear cells and most notably had an inhibitory effect on immune cells potentially limiting their cytotoxic potential. Hence, cytotoxicity increased in a dose-dependent manner when BV6 was removed before CIK cells were added to tumor targets. However, cytotoxic potential was not further increasable by extending BV6 pre-incubation period of target cells from 4 to 12 h. Molecular studies revealed that BV6 sensitization of target cells involved activation of caspases. Here, we provide evidence that SMAC mimetic may sensitize targets cells for CIK cell-induced cell death. However, BV6 also increased apoptosis of non-malignant cells like CIK cells and peripheral mononuclear cells. These findings may therefore be important for cell- and small molecule IAP-based combination therapies of resistant cancers after allogeneic HSCT.
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Affiliation(s)
- Eva Rettinger
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Andreas Glatthaar
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Behnaz Ahangarian Abhari
- Institute for Experimental Cancer Research in Pediatrics, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Sarah Oelsner
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany ; Georg-Speyer-Haus, Institute for Biomedical Research , Frankfurt , Germany
| | - Verena Pfirrmann
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Sabine Huenecke
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Selim Kuçi
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Hermann Kreyenberg
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Andre M Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Simone Fulda
- Institute for Experimental Cancer Research in Pediatrics, Goethe University Frankfurt am Main , Frankfurt , Germany
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main , Frankfurt , Germany
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11
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Brehm C, Huenecke S, Pfirrmann V, Rossig C, Mackall CL, Bollard CM, Gottschalk S, Schlegel PG, Klingebiel T, Bader P. Highlights of the third International Conference on Immunotherapy in Pediatric Oncology. Pediatr Hematol Oncol 2013; 30:349-66. [PMID: 23758210 DOI: 10.3109/08880018.2013.802106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The third International Conference on Immunotherapy in Pediatric Oncology was held in Frankfurt/Main, Germany, October 1-2, 2012. Major topics of the conference included (i) cellular therapies using antigen-specific and gene-modified T cells for targeting leukemia and pediatric solid tumors; (ii) overcoming hurdles and barriers with regard to immunogenicity, immune escape, and the role of tumor microenvironment; (iii) vaccine strategies and antigen presentation; (iv) haploidentical transplantation and innate immunity; (v) the role of immune cells in allogeneic transplantation; and (vi) current antibody/immunoconjugate approaches for the treatment of pediatric malignancies. During the past decade, major advances have been made in improving the efficacy of these modalities and regulatory hurdles have been taken. Nevertheless, there is still a long way to go to fully exploit the potential of immunotherapeutic strategies to improve the cure of children and adolescents with malignancies. This and future meetings will support new collaborations and insights for further translational and clinical immunotherapy studies.
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Affiliation(s)
- Claudia Brehm
- Department for Stem Cell Transplantation and Immunology, J.W. Goethe-University Hospital, University Hospital for Children and Adolescents, Frankfurt/Main, Germany
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