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Bouzianas D, Bouziana S. First pediatric B-acute lymphoblastic leukemia patient treated with anti-CD19 chimeric antigen receptor T-cell therapy: Long-term remission or early cure? Hum Vaccin Immunother 2024; 20:2321678. [PMID: 38402637 PMCID: PMC10898498 DOI: 10.1080/21645515.2024.2321678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Dimitrios Bouzianas
- BReMeL, Biopharmaceutical and Regenerative Medicine Laboratories, Thessaloniki, Greece
| | - Stella Bouziana
- Department of Hematology, King’s College Hospital, London, UK
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2
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Pirani T, Wilson A, Brealey D, Low R, O'Neill S, Le J, Jhanji S, Bangash MN, Mathew A, Wright C, Latif AL, Irvine D, Kasipandian V, Singh N, Saha R, Metaxa V. Critical care utilisation for patients receiving chimeric antigen receptor (CAR) T cell therapy in the UK. Br J Anaesth 2024; 132:1004-1006. [PMID: 38521658 DOI: 10.1016/j.bja.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 03/25/2024] Open
Affiliation(s)
- Tasneem Pirani
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony Wilson
- Department of Critical Care and Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | - David Brealey
- Critical Care Department, University College London Hospital NHS Foundation Trust, London, UK
| | - Ryan Low
- Division of Clinical Haematology, University College London Hospitals, London, UK
| | - Suzanne O'Neill
- Department of Critical Care and Anaesthesia, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jenny Le
- Haematology Department, University Hospital Bristol and Weston, Bristol, UK
| | - Shaman Jhanji
- Critical Care Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mansoor N Bangash
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Amrith Mathew
- Haematology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Wright
- Department of Intensive Care, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Anne-Louise Latif
- Haematology Department, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - David Irvine
- Haematology Department, Greater Glasgow and Clyde NHS Foundation Trust, Glasgow, UK
| | - Vidya Kasipandian
- Critical Care Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Neeraj Singh
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Rohit Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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3
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Mercadal S, Mussetti A, Lee CJ, Arevalo C, Odstrcil SM, Peña E, Sureda A, Couriel DR. Allogeneic stem cell transplantation and CAR-T in B-cell Non-Hodgkin Lymphoma: a two-center experience and review of the literature. Ann Hematol 2024; 103:1717-1727. [PMID: 38429536 DOI: 10.1007/s00277-024-05677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is still a potentially curative option for B-cell Non-Hodgkin Lymphoma (B-NHL) in the modern immunotherapy era. The objective of this study was to analyze long-term outcomes of patients with B-NHL who received allo-HSCT. We analyzed overall survival (OS), progression-free survival (PFS) and graft versus host disease (GVHD) relapse-free survival (GRFS) in 53 patients undergoing allo-HSCT from two institutions. The median follow-up of the study was 72 months (range 29-115 months). The median number of lines of therapy before allo-HSCT was 3 (range 1-6) and twenty-eight patients (53%) had received a previous autologous transplant. The 3-year PFS, OS and GRFS were 55%, 63%, and 55%, respectively. One-year non-relapse mortality was 26%. Karnofsky Performance Scale < 90 was associated with worse OS in multivariable analysis. A non-comparative analysis of a cohort of 44 patients with similar characteristics who received chimeric antigen receptor T-cell therapy was done, showing a 1-year PFS and OS were 60% and 66%, respectively. Our data shows that allo-HSCT is still a useful option for treating selected patients with R/R B-NHL. Our retrospective analysis and review of the literature demonstrate that allo-HSCT can provide durable remissions in a subset of patients with R/R B-NHL.
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Affiliation(s)
- Santiago Mercadal
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA.
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA.
| | - Alberto Mussetti
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Catherine J Lee
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Carolina Arevalo
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Silvina M Odstrcil
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Esteban Peña
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
| | - Anna Sureda
- Bone Marrow Transplant and Cellular Therapy Unit, Catalan Institute of Oncology, Hospital Duran I Reynals, Barcelona, Spain
| | - Daniel R Couriel
- Transplant and Cellular Therapy Program, Huntsman Cancer Institute, University of Utah, Utah, USA
- Cellular Therapy and Regenerative Medicine, University of Utah, Utah, USA
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4
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Harrer DC, Li SS, Kaljanac M, Bezler V, Barden M, Pan H, Herr W, Abken H. Magnetic CAR T cell purification using an anti-G4S linker antibody. J Immunol Methods 2024; 528:113667. [PMID: 38574803 DOI: 10.1016/j.jim.2024.113667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
Chimeric antigen receptor (CAR) redirected T cells are successfully employed in the combat against several hematological malignancies, however, are often compromised by low transduction rates making refinement of the CAR T cell products necessary. Here, we report a broadly applicable enrichment protocol relying on marking CAR T cells with an anti-glycine4-serine (G4S) linker antibody followed by magnetic activated cell sorting (MACS). The protocol is broadly applicable since the G4S peptide is an integral part of the vast majority of CARs as it links the VH and VL recognition domains. We demonstrate the feasibility by using the canonical second generation CARs specific for CEA and Her2, respectively, obtaining highly purified CAR T cell products in a one-step procedure without impairing cell viability. The protocol is also applicable to a dual specific CAR (tandem CAR). Except for CD39, T cell activation/exhaustion markers were not upregulated after separation. Purified CAR T cells retained their functionality with respect to antigen-specific cytokine secretion, cytotoxicity, and the capacity to proliferate and eliminate cognate tumor cells upon repetitive stimulation. Collectively, the one-step protocol for purifying CAR T cells extends the toolbox for preclinical research and specifically for clinical CAR T cell manufacturing.
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Affiliation(s)
- Dennis Christoph Harrer
- Department of Internal Medicine III - Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany; Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany.
| | - Sin-Syue Li
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany; Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Marcell Kaljanac
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany
| | - Valerie Bezler
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany
| | - Markus Barden
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany
| | - Hong Pan
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III - Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Hinrich Abken
- Leibniz Institute for Immunotherapy, Div. Genetic Immunotherapy, Regensburg, and Chair Genetic Immunotherapy, University Regensburg, Germany
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5
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Zhang K, Hu W, Li F, Wen C, Zhou L, Zhang L, Lian J, Liu S, Wang S, Zhang Y. IL-24 improves efficacy of CAR-T cell therapy by targeting stemness of tumor cells. Br J Cancer 2024; 130:1337-1347. [PMID: 38347092 PMCID: PMC11015030 DOI: 10.1038/s41416-024-02601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Cancer stem cells (CSCs) induce therapeutic resistance and may be an important barrier to cancer immunotherapy. Chimeric antigen receptor T (CAR-T) cell therapy has demonstrated remarkable efficacy in clinical settings. However, CAR-T cell therapy fails in a large proportion of patients, especially in those with solid tumors. It is unclear how CSCs mediate resistance to CAR-T cells, and whether CAR-T cells can more effectively eradicate CSCs. METHODS In this study, the effect of CSCs on CAR-T cell therapy was determined using in vitro and in vivo assays. Subsequently, Interleukin-24 (IL-24) was expressed along with CAR in T cells. Further in vitro and in vivo tests were performed to determine the effects of IL-24 on CSCs and CAR-T cell therapy. RESULTS IL-24 induced apoptosis in CSCs and contributed to T cell activation, differentiation, and proliferation. CAR.IL-24-T cells inhibited CSC enrichment and exhibited stronger antitumor activity in vitro and in vivo. CONCLUSIONS IL-24 helps eliminate CSCs and endows CAR-T cells with improved antitumor reactivity.
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Affiliation(s)
- Kai Zhang
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenhao Hu
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Feng Li
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chunli Wen
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lingxiao Zhou
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lei Zhang
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jingyao Lian
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shasha Liu
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shumin Wang
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Zhang
- Biotherapy Center & Cancer Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou, Henan, China.
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China.
- Henan Key Laboratory for Tumor Immunology and Biotherapy, Zhengzhou, Henan, China.
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6
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Fanqiao M, Chen X, Ren X, Li L, Wu T. CD7 CAR T bridging to allo-HSCT in R/R T-ALL: A case report. Pediatr Transplant 2024; 28:e14367. [PMID: 35860981 DOI: 10.1111/petr.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/15/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Refractory/relapsed T-cell acute lymphoblastic leukemia (R/R T-ALL) is a hematological malignancy with a poor prognosis. The current treatment strategy has not benefited most patients, and the treatment methods are still being explored. CASE PRESENTATION An 8-year-old boy with R/R T-ALL achieved CR after multiple chemotherapies, followed by the first allo-HSCT. Unfortunately, 1 year and 3 months later, he relapsed. After recurrence, the patient underwent multiple chemotherapies, but the NOTCH1 gene and MRD were still positive. FCM and immunohistochemistry revealed abnormally high expression of CD7, so we considered bridging the second allo-HSCT after CD7 CAR T-cells treatment. The patient has low toxic and side effects and is still in CR, findings from this case report have more important therapeutic significance for R/R T-ALL. CONCLUSION In conclusion, CD7 CAR T-cells bridging to allo-HSCT is a safe and effective approach for R/R T-ALL, resulting in durable CR and longer survival.
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Affiliation(s)
- Meng Fanqiao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Bone Marrow Transplantation, Beijing Boren Hospital, Beijing, China
| | - Xiuqiong Chen
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaotong Ren
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lijuan Li
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tong Wu
- Department of Bone Marrow Transplantation, Beijing Boren Hospital, Beijing, China
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7
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CAR T-Cells and Safety Signals: ITT Episode 29. N Engl J Med 2024; 390:e39. [PMID: 38657243 DOI: 10.1056/NEJMp2400701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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8
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Blaise D. CAR as Booster to Launch Allogeneic Transplantation in Refractory Leukemia. N Engl J Med 2024; 390:1526-1527. [PMID: 38657249 DOI: 10.1056/nejme2403003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Didier Blaise
- From the Department of Hematology, Transplant and Cellular Immunotherapy Program, Institut Paoli Calmettes, Management Sport Cancer laboratory, Aix-Marseille University, Marseille, France
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9
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Rejeski K, Wang Y, Hansen DK, Iacoboni G, Bachy E, Bansal R, Penack O, Müller F, Bethge W, Munoz J, Mohty R, Bücklein VL, Barba P, Locke FL, Lin Y, Jain MD, Subklewe M. Applying the EHA/EBMT grading for ICAHT after CAR-T: comparative incidence and association with infections and mortality. Blood Adv 2024; 8:1857-1868. [PMID: 38181508 PMCID: PMC11007437 DOI: 10.1182/bloodadvances.2023011767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Cytopenias represent the most common side effect of CAR T-cell therapy (CAR-T) and can predispose for severe infectious complications. Current grading systems, such as the Common Terminology Criteria for Adverse Events (CTCAE), neither reflect the unique quality of post-CAR-T neutrophil recovery, nor do they reflect the inherent risk of infections due to protracted neutropenia. For this reason, a novel EHA/EBMT consensus grading was recently developed for Immune Effector Cell-Associated HematoToxicity (ICAHT). In this multicenter, observational study, we applied the grading system to a large real-world cohort of 549 patients treated with BCMA- or CD19-directed CAR-T for refractory B-cell malignancies (112 multiple myeloma [MM], 334 large B-cell lymphoma [LBCL], 103 mantle cell lymphoma [MCL]) and examined the clinical sequelae of severe (≥3°) ICAHT. The ICAHT grading was strongly associated with the cumulative duration of severe neutropenia (r = 0.92, P < .0001), the presence of multilineage cytopenias, and the use of platelet and red blood cell transfusions. We noted an increased rate of severe ICAHT in patients with MCL vs those with LBCL and MM (28% vs 23% vs 15%). Severe ICAHT was associated with a higher rate of severe infections (49% vs 13%, P < .0001), increased nonrelapse mortality (14% vs 4%, P < .0001), and inferior survival outcomes (1-year progression-free survival: 35% vs 51%, 1-year overall survival: 52% vs 73%, both P < .0001). Importantly, the ICAHT grading demonstrated superior capacity to predict severe infections compared with the CTCAE grading (c-index 0.73 vs 0.55, P < .0001 vs nonsignificant). Taken together, these data highlight the clinical relevance of the novel grading system and support the reporting of ICAHT severity in clinical trials evaluating CAR-T therapies.
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Affiliation(s)
- Kai Rejeski
- Department of Medicine III – Hematology/Oncology, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK), Munich and Berlin Sites, and German Cancer Research Center, Heidelberg, Germany
- Adult BMT and Cellular Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Doris K. Hansen
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Gloria Iacoboni
- Department of Hematology, Vall d’Hebron Institute of Oncology, University Hospital Vall d’Hebron and Autonomous University of Barcelona, Barcelona, Spain
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital, Claude Bernard University Lyon 1, INSERM 1052, Pierre-Bénite, France
| | | | - Olaf Penack
- German Cancer Consortium (DKTK), Munich and Berlin Sites, and German Cancer Research Center, Heidelberg, Germany
- Department of Hematology, Oncology and Tumorimmunology, Charité – Berlin University Medicine, Corporate Member of Free University of Berlin and Humboldt University, Berlin, Germany
| | - Fabian Müller
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Bethge
- Department of Hematology, Oncology, Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Javier Munoz
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Razan Mohty
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Veit L. Bücklein
- Department of Medicine III – Hematology/Oncology, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
| | - Pere Barba
- Department of Hematology, Vall d’Hebron Institute of Oncology, University Hospital Vall d’Hebron and Autonomous University of Barcelona, Barcelona, Spain
| | - Frederick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Marion Subklewe
- Department of Medicine III – Hematology/Oncology, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, LMU Gene Center, Munich, Germany
- German Cancer Consortium (DKTK), Munich and Berlin Sites, and German Cancer Research Center, Heidelberg, Germany
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10
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Herrero San Martin A, Alcala J, Gonzalez M, Velilla Alonso G, Martins G, Romero Coronado J. Immune Effector Cell-Associated Neurotoxicity Syndrome Related to Chimeric Antigen Receptor T-Cell Therapy. Neurology 2024; 102:e209266. [PMID: 38507663 DOI: 10.1212/wnl.0000000000209266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Alejandro Herrero San Martin
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
| | - Juan Alcala
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
| | - Maialen Gonzalez
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
| | - Gabriel Velilla Alonso
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
| | - Guilherme Martins
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
| | - Juan Romero Coronado
- From the Departments of Neurology (A.H.S.M., J.A., M.G., G.V.A.) and Radiology (G.M., J.R.C.), and Group of Neurodegenerative Diseases (A.H.S.M.), Investigation Institute, Hospital Universitario 12 de Octubre; and Biomedical Research Networking Center in Neurodegenerative Diseases (CIBERNED) (A.H.S.M.), Madrid, Spain
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11
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Shi M, Wang J, Huang H, Liu D, Cheng H, Wang X, Chen W, Yan Z, Sang W, Qi K, Li D, Zhu F, Li Z, Qiao J, Wu Q, Zeng L, Fei X, Gu W, Miao Y, Xu K, Zheng J, Cao J. Bispecific CAR T cell therapy targeting BCMA and CD19 in relapsed/refractory multiple myeloma: a phase I/II trial. Nat Commun 2024; 15:3371. [PMID: 38643278 PMCID: PMC11032309 DOI: 10.1038/s41467-024-47801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
Despite the high therapeutic response achieved with B-cell maturation antigen (BCMA)-specific chimeric antigen receptor (CAR) T-cell therapy in relapsed and refractory multiple myeloma (R/R MM), primary resistance and relapse exist with single-target immunotherapy. Here, we design bispecific BC19 CAR T cells targeting BCMA/CD19 and evaluate antimyeloma activity in vitro and in vivo. Preclinical results indicate that BC19 CAR specifically recognize target antigens, and BC19 CAR T cells mediate selective killing of BCMA or CD19-positive cancer cells. BC19 CAR T cells also exhibit potent antigen-specific anti-tumor activity in xenograft mouse models. We conduct an open-label, single-arm, phase I/II study of BC19 CAR T cells in 50 patients with R/R MM (ChiCTR2000033567). The primary endpoint was safety. BC19 CAR T cells are well tolerated with grade 3 or higher cytokine release syndrome in 8% of patients and grade 1 neurotoxic events in 4% of patients, which meet the pre-specified primary endpoint. Secondary endpoints include overall response rate (92%), median progression-free survival (19.7 months), median overall survival (19.7 months) and median duration of response (not reached). Our study demonstrates that bispecific BC19 CAR T cells are feasible, safe and effective in treating patients with R/R MM.
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Affiliation(s)
- Ming Shi
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
| | - Jiaojiao Wang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Hongming Huang
- Department of Hematology, The Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Dan Liu
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China
| | - Hai Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Xu Wang
- Cancer Institute, Xuzhou Medical University, Xuzhou, 221002, China
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China
| | - Wei Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Wei Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Kunming Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Depeng Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Feng Zhu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Zhenyu Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Jianlin Qiao
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Qingyun Wu
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Lingyu Zeng
- Jiangsu Bone Marrow Stem Cell Institute, Xuzhou, 221002, China
| | - Xiaoming Fei
- Department of Hematology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
| | - Weiying Gu
- Department of Hematology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, 213000, China
| | - Yuqing Miao
- Department of Hematology, Yancheng No. People's Hospital, Yancheng, 224006, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
| | - Junnian Zheng
- Center of Clinical Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
- Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Xuzhou Medical University, Xuzhou, 221002, China.
| | - Jiang Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
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12
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Xiong Q, Wang H, Shen Q, Wang Y, Yuan X, Lin G, Jiang P. The development of chimeric antigen receptor T-cells against CD70 for renal cell carcinoma treatment. J Transl Med 2024; 22:368. [PMID: 38637886 PMCID: PMC11025280 DOI: 10.1186/s12967-024-05101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
In this study, we investigated CD70 as a promising target for renal cell carcinoma (RCC) therapy and developed a potent chimeric antigen receptor T (CAR-T) cells for potential clinical testing. CD70, found to be highly expressed in RCC tumors, was associated with decreased survival. We generated CAR-T cells expressing VHH sequence of various novel nanobodies from immunized alpaca and a single-chain variable fragment (scFv) derived from human antibody (41D12). In our in vitro experiments, anti-CD70 CAR-T cells effectively eliminated CD70-positive tumor cells while sparing CD70-negative cells. The nanobody-based CAR-T cells demonstrated significantly higher production of cytokines such as IL-2, IFN-γ and TNF-ɑ during co-culture, indicating their potential for enhanced functionality. In xenograft mouse model, these CAR-T cells exhibited remarkable anti-tumor activity, leading to the eradication of RCC tumor cells. Importantly, human T cell expansion after infusion was significantly higher in the VHH groups compared to the scFv CAR-T group. Upon re-challenging mice with RCC tumor cells, the VHH CAR-T treated group remained tumor-free, suggesting a robust and long-lasting anti-tumor response. These findings provide strong support for the potential of nanobody-based CD70 CAR-T cells as a promising therapeutic option for RCC. This warrants further development and consideration for future clinical trials and applications.
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Affiliation(s)
- Qinghui Xiong
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China.
| | - Haiying Wang
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China.
| | - Qiushuang Shen
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China
| | - Yan Wang
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China
| | - Xiujie Yuan
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China
| | - Guangyao Lin
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China
| | - Pengfei Jiang
- Shanghai HRAIN Biotechnology Co., Ltd., 1238 Zhangjiang Road, Shanghai, 201203, China
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13
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Ma S, Wang Y, Qi K, Lu W, Qi Y, Cao J, Niu M, Li D, Sang W, Yan Z, Zhu F, Cheng H, Li Z, Zhao M, Xu K. Associations of granulocyte colony-stimulating factor with toxicities and efficacy of chimeric antigen receptor T-cell therapy in relapsed or refractory B-cell acute lymphoblastic leukemia. Cancer Immunol Immunother 2024; 73:104. [PMID: 38630258 DOI: 10.1007/s00262-024-03661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
Few studies have reported the associations of granulocyte colony-stimulating factor (G-CSF) with cytokine release syndrome (CRS), neurotoxic events (NEs) and efficacy after chimeric antigen receptor (CAR) T-cell therapy for relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). We present a retrospective study of 67 patients with R/R B-ALL who received anti-CD19 CAR T-cell therapy, 41 (61.2%) patients received G-CSF (G-CSF group), while 26 (38.8%) did not (non-G-CSF group). Patients had similar duration of grade 3-4 neutropenia between the two groups. The incidences of CRS and NEs were higher in G-CSF group, while no differences in severity were found. Further stratified analysis showed that the incidence and severity of CRS were not associated with G-CSF administration in patients with low bone marrow (BM) tumor burden. None of the patients with low BM tumor burden developed NEs. However, there was a significant increase in the incidence of CRS after G-CSF administration in patients with high BM tumor burden. The duration of CRS in patients who used G-CSF was longer. There were no significant differences in response rates at 1 and 3 months after CAR T-cell infusion, as well as overall survival (OS) between the two groups. In conclusion, our results showed that G-CSF administration was not associated with the incidence or severity of CRS in patients with low BM tumor burden, but the incidence of CRS was higher after G-CSF administration in patients with high BM tumor burden. The duration of CRS was prolonged in G-CSF group. G-CSF administration was not associated with the efficacy of CAR T-cell therapy.
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Affiliation(s)
- Sha Ma
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Ying Wang
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Kunming Qi
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Wenyi Lu
- Department of Hematology, Tianjin First Central Hospital, No. 24 Fu Kang Road, Tianjin, 300192, China
| | - Yuekun Qi
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Jiang Cao
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Mingshan Niu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
| | - Depeng Li
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Wei Sang
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Zhiling Yan
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Feng Zhu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Hai Cheng
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China
| | - Zhenyu Li
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China.
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China.
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, No. 24 Fu Kang Road, Tianjin, 300192, China.
| | - Kailin Xu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou, China.
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, No. 99 West Huaihai Road, Xuzhou, 221002, Jiangsu, China.
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14
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Saunthararajah Y. Oncotherapy resistance explained by Darwinian and Lamarckian models. J Clin Invest 2024; 134:e179788. [PMID: 38618954 PMCID: PMC11014649 DOI: 10.1172/jci179788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Cell and antibody therapies directed against surface molecules on B cells, e.g., CD19-targeting chimeric antigen receptor T cells (CD19 CAR-T), are now standard for patients with chemorefractory B cell acute lymphoblastic leukemias and other B cell malignancies. However, early relapse rates remain high. In this issue of the JCI, Aminov, Giricz, and colleagues revealed that leukemia cells resisting CD19-targeted therapy had reduced CD19 but also low CD22 expression and were sensitive to Bruton's tyrosine kinase and/or MEK inhibition. Overall, their observations support the evolution of resistance following a Lamarckian model: the oncotherapy directly elicits adaptive, resistance-conferring reconfigurations, which are then inherited by daughter cells as epigenetic changes. The findings prompt reflection also on the broader role of epigenetics in decoupling of replication from lineage differentiation activation by the B cell lineage master transcription factor hub. Such oncogenesis and resistance mechanisms, being predictable and epigenetic, offer practical opportunities for intervention, potentially non-cross-resistant and safe vis-à-vis present cytotoxic and CAR-T treatments.
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15
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Oporto Espuelas M, Burridge S, Kirkwood AA, Bonney D, Watts K, Shenton G, Jalowiec KA, O'Reilly MA, Roddie C, Castleton A, Clesham K, Nicholson E, Alajangi R, Prabhu S, George L, Uttenthal B, Gabelli M, Neill L, Besley C, Chaganti S, Wynn RF, Bartram J, Chiesa R, Lucchini G, Pavasovic V, Rao A, Rao K, Silva J, Samarasinghe S, Vora A, Clark P, Cummins M, Marks DI, Amrolia P, Hough R, Ghorashian S. Intention-to-treat outcomes utilising a stringent event definition in children and young people treated with tisagenlecleucel for r/r ALL through a national access scheme. Blood Cancer J 2024; 14:66. [PMID: 38622139 PMCID: PMC11018620 DOI: 10.1038/s41408-024-01038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
CAR T-cell therapy has transformed relapsed/refractory (r/r) B-cell precursor acute lymphoblastic leukaemia (B-ALL) management and outcomes, but following CAR T infusion, interventions are often needed. In a UK multicentre study, we retrospectively evaluated tisagenlecleucel outcomes in all eligible patients, analysing overall survival (OS) and event-free survival (EFS) with standard and stringent definitions, the latter including measurable residual disease (MRD) emergence and further anti-leukaemic therapy. Both intention-to-treat and infused cohorts were considered. We collected data on feasibility of delivery, manufacture, toxicity, cause of therapy failure and followed patients until death from any cause. Of 142 eligible patients, 125 received tisagenlecleucel, 115/125 (92%) achieved complete remission (CR/CRi). Severe cytokine release syndrome and neurotoxicity occurred in 16/123 (13%) and 10/123 (8.1%), procedural mortality was 3/126 (2.4%). The 2-year intent to treat OS and EFS were 65.2% (95%CI 57.2-74.2%) and 46.5% (95%CI 37.6-57.6%), 2-year intent to treat stringent EFS was 35.6% (95%CI 28.1-44.9%). Median OS was not reached. Sixty-two responding patients experienced CAR T failure by the stringent event definition. Post failure, 1-year OS and standard EFS were 61.2% (95%CI 49.3-75.8) and 55.3% (95%CI 43.6-70.2). Investigation of CAR T-cell therapy for B-ALL delivered on a country-wide basis, including following patients beyond therapy failure, provides clinicians with robust outcome measures. Previously, outcomes post CAR T-cell therapy failure were under-reported. Our data show that patients can be successfully salvaged in this context with good short-term survival.
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Affiliation(s)
- Macarena Oporto Espuelas
- Infection, Immunity and Inflammation, UCL Great Ormond Ormond Street Institute of Child Health, London, UK.
| | - Saskia Burridge
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & Cancer Trials Centre, UCL, London, UK
| | - Denise Bonney
- Department of Blood and Bone Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - Kelly Watts
- Department of Blood and Bone Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - Geoff Shenton
- Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Katarzyna A Jalowiec
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maeve A O'Reilly
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Roddie
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anna Castleton
- Department of Haematology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Katherine Clesham
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emma Nicholson
- Department of Haematology/Bone Marrow Transplantation, The Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Rajesh Alajangi
- Department of Haematology/Bone Marrow Transplant, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Shilpa Prabhu
- Department of Haematology/Bone Marrow Transplant, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Lindsay George
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Uttenthal
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Maria Gabelli
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
- Pediatric Onco-hematology and Hematopoietic Stem Cell Transplantation, Woman and Child Health Department, University of Padova, Padua, Italy
| | - Lorna Neill
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Caroline Besley
- Department of Haematology/Bone Marrow Transplant, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sridhar Chaganti
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Robert F Wynn
- Department of Blood and Bone Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Robert Chiesa
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
| | - Giovanna Lucchini
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Anupama Rao
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Kanchan Rao
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
| | - Juliana Silva
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
| | | | - Ajay Vora
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | | | | | - David I Marks
- Department of Haematology, University Hospitals Bristol, Bristol, UK
| | - Persis Amrolia
- Infection, Immunity and Inflammation, UCL Great Ormond Ormond Street Institute of Child Health, London, UK
- Department of Bone Marrow Transplant, Great Ormond Street Hospital, London, UK
| | - Rachael Hough
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sara Ghorashian
- Department of Haematology, Great Ormond Street Hospital, London, UK
- Developmental Biology and Cancer, UCL Great Ormond Ormond Street Institute of Child Health, London, UK
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16
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Richter J. Like a bridge over troubled water: keeping the myeloma down en route to CAR-T. Blood Cancer J 2024; 14:64. [PMID: 38609377 PMCID: PMC11015014 DOI: 10.1038/s41408-024-01049-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Joshua Richter
- Tisch Cancer Institute: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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17
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Afrough A, Hashmi H, Hansen DK, Sidana S, Ahn C, Peres LC, Dima D, Freeman CL, Puglianini OC, Kocoglu MH, Atrash S, Voorhees PM, Shune L, McGuirk JP, Simmons G, Sborov DW, Davis JA, Kaur G, Sannareddy A, Ferreri CJ, Gaballa MR, Goldsmith S, Nadeem O, Midha S, Wagner CB, Locke FL, Patel KK, Khouri J, Anderson LD, Lin Y. Real-world impact of bridging therapy on outcomes of ide-cel for myeloma in the U.S. Myeloma Immunotherapy Consortium. Blood Cancer J 2024; 14:63. [PMID: 38609386 PMCID: PMC11015040 DOI: 10.1038/s41408-024-00993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Aimaz Afrough
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Hamza Hashmi
- Medical University of South Carolina, Charleston, SC, USA
| | - Doris K Hansen
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Surbhi Sidana
- Stanford University School of Medicine, Stanford, CA, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lauren C Peres
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Danai Dima
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Ciara L Freeman
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Mehmet H Kocoglu
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | | | | | - Leyla Shune
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Gary Simmons
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Douglas W Sborov
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James A Davis
- Medical University of South Carolina, Charleston, SC, USA
| | - Gurbakhash Kaur
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Aishwarya Sannareddy
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Omar Nadeem
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Charlotte B Wagner
- The University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Krina K Patel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Khouri
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Larry D Anderson
- Myeloma, Waldenstrom's, and Amyloidosis Program, Hematologic Malignancies and Cellular Therapy Program, Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
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18
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Lin K, Xia B, Wang X, He X, Zhou M, Lin Y, Qiao Y, Li R, Chen Q, Li Y, Feng J, Chen T, Chen C, Li X, Zhang H, Lu L, Liu B, Zhang X. Development of nanobodies targeting hepatocellular carcinoma and application of nanobody-based CAR-T technology. J Transl Med 2024; 22:349. [PMID: 38610029 PMCID: PMC11015683 DOI: 10.1186/s12967-024-05159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Chimeric antigen receptor T (CAR-T) cell therapy, as an emerging anti-tumor treatment, has garnered extensive attention in the study of targeted therapy of multiple tumor-associated antigens in hepatocellular carcinoma (HCC). However, the suppressive microenvironment and individual heterogeneity results in downregulation of these antigens in certain patients' cancer cells. Therefore, optimizing CAR-T cell therapy for HCC is imperative. METHODS In this study, we administered FGFR4-ferritin (FGFR4-HPF) nanoparticles to the alpaca and constructed a phage library of nanobodies (Nbs) derived from alpaca, following which we screened for Nbs targeting FGFR4. Then, we conducted the functional validation of Nbs. Furthermore, we developed Nb-derived CAR-T cells and evaluated their anti-tumor ability against HCC through in vitro and in vivo validation. RESULTS Our findings demonstrated that we successfully obtained high specificity and high affinity Nbs targeting FGFR4 after screening. And the specificity of Nbs targeting FGFR4 was markedly superior to their binding to other members of the FGFR family proteins. Furthermore, the Nb-derived CAR-T cells, targeting FGFR4, exhibited significantly enhanced anti-tumor efficacy in both experiments when in vitro and in vivo. CONCLUSIONS In summary, the results of this study suggest that the CAR-T cells derived from high specificity and high affinity Nbs, targeting FGFR4, exhibited significantly enhanced anti-tumor efficacy in vitro and in vivo. This is an exploration of FGFR4 in the field of Nb-derived CAR-T cell therapy for HCC, holding promise for enhancing safety and effectiveness in the clinical treatment of HCC in the future.
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Affiliation(s)
- Keming Lin
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Baijin Xia
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Xuemei Wang
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Xin He
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Mo Zhou
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yingtong Lin
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yidan Qiao
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Rong Li
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Qier Chen
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Yuzhuang Li
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Jinzhu Feng
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Tao Chen
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Cancan Chen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xinyu Li
- Shenzhen Key Laboratory of Systems Medicine for Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-sen University, Shenzhen, Guangdong, People's Republic of China
| | - Hui Zhang
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Lijuan Lu
- Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Avenue, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Bingfeng Liu
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China.
| | - Xu Zhang
- Institute of Human Virology, Key Laboratory of Tropical Disease Control of Ministry of Education, Guangdong Engineering Research Center for Antimicrobial Agent and Immunotechnology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74 Zhongshan Road 2, Yuexiu District, Guangzhou, Guangdong, 510080, People's Republic of China.
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19
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Kampouri E, Ibrahimi SS, Xie H, Wong ER, Hecht JB, Sekhon MK, Vo A, Stevens-Ayers TL, Green DJ, Gauthier J, Maloney DG, Perez A, Jerome KR, Leisenring WM, Boeckh MJ, Hill JA. Cytomegalovirus (CMV) Reactivation and CMV-Specific Cell-Mediated Immunity After Chimeric Antigen Receptor T-Cell Therapy. Clin Infect Dis 2024; 78:1022-1032. [PMID: 37975819 PMCID: PMC11006113 DOI: 10.1093/cid/ciad708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The epidemiology of cytomegalovirus (CMV) after chimeric antigen receptor-modified T-cell immunotherapy (CARTx) is poorly understood owing to a lack of routine surveillance. METHODS We prospectively enrolled 72 adult CMV-seropositive CD19-, CD20-, or BCMA-targeted CARTx recipients and tested plasma samples for CMV before and weekly up to 12 weeks after CARTx. We assessed CMV-specific cell-mediated immunity (CMV-CMI) before and 2 and 4 weeks after CARTx, using an interferon γ release assay to quantify T-cell responses to IE-1 and pp65. We tested pre-CARTx samples to calculate a risk score for cytopenias and infection (CAR-HEMATOTOX). We used Cox regression to evaluate CMV risk factors and evaluated the predictive performance of CMV-CMI for CMV reactivation in receiver operator characteristic curves. RESULTS CMV was detected in 1 patient (1.4%) before and in 18 (25%) after CARTx, for a cumulative incidence of 27% (95% confidence interval, 16.8-38.2). The median CMV viral load (interquartile range) was 127 (interquartile range, 61-276) IU/mL, with no end-organ disease observed; 5 patients received preemptive therapy based on clinical results. CMV-CMI values reached a nadir 2 weeks after infusion and recovered to baseline levels by week 4. In adjusted models, BCMA-CARTx (vs CD19/CD20) and corticosteroid use for >3 days were significantly associated with CMV reactivation, and possible associations were detected for lower week 2 CMV-CMI and more prior antitumor regimens. The cumulative incidence of CMV reactivation almost doubled when stratified by BCMA-CARTx target and use of corticosteroids for >3 days (46% and 49%, respectively). CONCLUSIONS CMV testing could be considered between 2 and 6 weeks in high-risk CARTx recipients.
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Affiliation(s)
- Eleftheria Kampouri
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Sarah S Ibrahimi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Elizabeth R Wong
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jessica B Hecht
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Mandeep K Sekhon
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Alythia Vo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Terry L Stevens-Ayers
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Damian J Green
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jordan Gauthier
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ailyn Perez
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Keith R Jerome
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Michael J Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
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20
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Ouyang W, Jin SW, Xu N, Liu WY, Zhao H, Zhang L, Kang L, Tao Y, Liu Y, Wang Y, Wang J, Liu F, Yu L, Liu Z, Mi JQ. PD-1 downregulation enhances CAR-T cell antitumor efficiency by preserving a cell memory phenotype and reducing exhaustion. J Immunother Cancer 2024; 12:e008429. [PMID: 38589248 PMCID: PMC11015237 DOI: 10.1136/jitc-2023-008429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Despite the encouraging outcome of chimeric antigen receptor T cell (CAR-T) targeting B cell maturation antigen (BCMA) in managing relapsed or refractory multiple myeloma (RRMM) patients, the therapeutic side effects and dysfunctions of CAR-T cells have limited the efficacy and clinical application of this promising approach. METHODS In this study, we incorporated a short hairpin RNA cassette targeting PD-1 into a BCMA-CAR with an OX-40 costimulatory domain. The transduced PD-1KD BCMA CAR-T cells were evaluated for surface CAR expression, T-cell proliferation, cytotoxicity, cytokine production, and subsets when they were exposed to a single or repetitive antigen stimulation. Safety and efficacy were initially observed in a phase I clinical trial for RRMM patients. RESULTS Compared with parental BCMA CAR-T cells, PD-1KD BCMA CAR-T cell therapy showed reduced T-cell exhaustion and increased percentage of memory T cells in vitro. Better antitumor activity in vivo was also observed in PD-1KD BCMA CAR-T group. In the phase I clinical trial of the CAR-T cell therapy for seven RRMM patients, safety and efficacy were initially observed in all seven patients, including four patients (4/7, 57.1%) with at least one extramedullary site and four patients (4/7, 57.1%) with high-risk cytogenetics. The overall response rate was 85.7% (6/7). Four patients had a stringent complete response (sCR), one patient had a CR, one patient had a partial response, and one patient had stable disease. Safety profile was also observed in these patients, with an incidence of manageable mild to moderate cytokine release syndrome and without the occurrence of neurological toxicity. CONCLUSIONS Our study demonstrates a design concept of CAR-T cells independent of antigen specificity and provides an alternative approach for improving the efficacy of CAR-T cell therapy.
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Affiliation(s)
- Wanyan Ouyang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Wei Jin
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Xu
- Shanghai Unicar-Therapy Bio-medicine Technology Co Ltd, Shanghai, China
| | - Wei-Yang Liu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Zhao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liuqingqing Zhang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Liqing Kang
- Shanghai Unicar-Therapy Bio-medicine Technology Co Ltd, Shanghai, China
| | - Yi Tao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanfang Liu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liu
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Yu
- Shanghai Unicar-Therapy Bio-medicine Technology Co Ltd, Shanghai, China
| | - Zhiqiang Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jian-Qing Mi
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Aggarwal S, Ip A, Koren Y, Poscover D, Ferreira C, Glasser L, Heil K, Varghese D, Venkatesan S, Talarico C. EPR24-110: Prior SARS-CoV-2 in Patients With CAR-T Negatively Impacts Overall Survival, Highlighting the Need for Targeted Prophylaxis Strategies. J Natl Compr Canc Netw 2024; 22:EPR24-110. [PMID: 38580234 DOI: 10.6004/jnccn.2023.7144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | - Andrew Ip
- 2John Theurer Cancer Center, Hackensack, NJ
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22
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Frosch ZAK, Meshack C, Meeker C, Varshavsky-Yanovsky A, Khanal R, Bromberg M, Chandar A, Quien E, Carter J, Nakhoda SK, Messmer M, Montgomery C, Incorvati JA, Ali ND, Styler MJ, Fang CY. YIA24-002: Patients' Perspectives on Being Treated by Multiple Care Teams for Autologous Transplant/CAR-T Eligible Lymphoma and Multiple Myeloma. J Natl Compr Canc Netw 2024; 22:YIA24-002. [PMID: 38580229 DOI: 10.6004/jnccn.2023.7123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | | | | | - Rashmi Khanal
- 1Fox Chase Cancer Center, Philadelphia PA
- 2Temple University Hospital, Philadelphia, PA
| | | | | | | | | | | | | | | | | | - Nadia D Ali
- 2Temple University Hospital, Philadelphia, PA
| | - Michael J Styler
- 1Fox Chase Cancer Center, Philadelphia PA
- 2Temple University Hospital, Philadelphia, PA
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23
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Alcaraz-Serna A, Porret R, Trueb L, Ribi C, Seebach J, Muller YD. [CAR-T therapy for autoimmune diseases]. Rev Med Suisse 2024; 20:688-693. [PMID: 38568061 DOI: 10.53738/revmed.2024.20.868.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Cellular therapy using genetically modified T lymphocytes expressing synthetic receptors, known as CAR (Chimeric Antigen Receptor), has revolutionized the treatment of certain hematologic malignancies. This success has led to exploring the same approach in the treatment of severe autoimmune diseases refractory to conventional therapies. Initial results in systemic lupus erythematosus have shown complete remissions that appear to persist over time. Consequently, there is a growing number of ongoing clinical trials. In this review, we discuss the rationale behind the use of CAR-T therapies, the targeted autoimmune diseases, and the associated risks.
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Affiliation(s)
- Ana Alcaraz-Serna
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Raphael Porret
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Lionel Trueb
- Service d'immuno-oncologie, Département d'oncologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Jörg Seebach
- Division d'immunologie et d'allergologie, Service d'immunologie et d'allergologie, Hôpitaux universitaires de Genève et Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Yannick D Muller
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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24
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Dima D, Rashid A, Davis JA, Shune L, Abdallah AO, Li H, DeJarnette S, Khouri J, Williams L, Hashmi H, Raza S, McGuirk J, Anwer F, Ahmed N. Efficacy and safety of idecabtagene vicleucel in patients with relapsed-refractory multiple myeloma not meeting the KarMMa-1 trial eligibility criteria: A real-world multicentre study. Br J Haematol 2024; 204:1293-1299. [PMID: 38263627 DOI: 10.1111/bjh.19302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Ide-cel received approval for relapsed-refractory multiple myeloma based on the results of the KarMMa-1 trial. However, patients with significant comorbidities, aggressive disease and prior B-cell maturation antigen-directed therapy (BCMA-DT) were excluded. This retrospective study evaluated real-world outcomes of patients who did not meet the KarMMa-1 eligibility criteria and were treated with standard of care (SOC) ide-cel. A total of 69 patients from three US centres who did not meet the KarMMa-1 criteria underwent ide-cel infusion. The main reasons for trial ineligibility included baseline grade 3-4 cytopenia (39%), prior BCMA-DT (26%), renal impairment (19%) and Eastern Cooperative Oncology Group performance status ≥2 (14.5%). Cytokine-release syndrome occurred in 81% vs. 84%, and immune effector cell-associated neurotoxicity syndrome occurred in 28% vs. 18% of SOC versus KarMMa-1 patients, respectively. Early infection (≤8 weeks post-infusion) and severe infection rates were 42% vs. 49% and 30% vs. 22% for the SOC versus KarMMa-1 cohorts, respectively. Grade 3-4 cytopenias for SOC versus KarMMa-1 cohorts were: neutropenia (87% vs. 89%), anaemia (51% vs. 60%) and thrombocytopenia (65% vs. 52%). Overall response rate was higher for the SOC cohort (93% vs. 73%), as was the complete response or better rate (48% vs. 33%). However, median progression-free survival and overall survival were comparable between the two groups. Our findings support broadening the inclusion criteria of future trials evaluating ide-cel.
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Affiliation(s)
- Danai Dima
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Department of Hematology-Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio, USA
| | - Aliya Rashid
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - James A Davis
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Department of Hematology-Oncology, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Leyla Shune
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Al-Ola Abdallah
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Hong Li
- Department of Biostatistics and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shaun DeJarnette
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Jack Khouri
- Department of Hematology-Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio, USA
| | - Louis Williams
- Department of Hematology-Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio, USA
| | - Hamza Hashmi
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Department of Hematology-Oncology, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Shahzad Raza
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
| | - Joseph McGuirk
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Faiz Anwer
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Department of Hematology-Oncology, Cleveland Clinic, Taussig Cancer Center, Cleveland, Ohio, USA
| | - Nausheen Ahmed
- US Myeloma Innovations Research Collaborative (USMIRC), Kansas City, Kansas, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
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25
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Nakamura N, Jo T, Arai Y, Kitawaki T, Nishikori M, Mizumoto C, Kanda J, Yamashita K, Nagao M, Takaori-Kondo A. Clinical Impact of Cytokine Release Syndrome on Prolonged Hematotoxicity after Chimeric Antigen Receptor T Cell Therapy: KyoTox A-Score, a Novel Prediction Model. Transplant Cell Ther 2024; 30:404-414. [PMID: 38281589 DOI: 10.1016/j.jtct.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 01/30/2024]
Abstract
Prolonged hematotoxicity is the most common long-term adverse event in chimeric antigen receptor T cell therapy (CAR-T). To evaluate the impact on prolonged cytopenia of inflammatory status after CAR T infusion, we performed a single-center retrospective study and analyzed patients with B cell lymphomas after CAR-T. Among 90 patients analyzed at 90 days after infusion, the cumulative incidence was 57.5% for prolonged neutropenia, 36.7% for anemia, and 49.8% for thrombocytopenia. Patients who experienced cytokine release syndrome (CRS) had significantly higher incidence and longer duration of prolonged cytopenia. In addition, we found that among patients with grade 1 CRS, those with a longer duration of CRS-related symptoms (>5 days; grade 1b in modified CRS grading [m-CRS]) had a significantly higher incidence and longer duration of prolonged cytopenia than those whose CRS-related symptoms resolved within 5 days (grade 1a m-CRS). Multivariate analysis revealed that a higher m-CRS grade (grade 1b or 2; hazard ratio [HR], 2.42), higher peak CRP (≥10 mg/dL; HR, 1.66), longer duration of elevated CRP (≥10 days; HR, 1.83), and a decrease in serum inorganic phosphorus concentration (≥30% from baseline; HR, 1.95) were associated with significantly higher cumulative incidence of prolonged neutropenia, as well as anemia and thrombocytopenia. Using these factors, we developed a new predictive scoring model for prolonged hematotoxicity, the KyoTox a-score, which can successfully stratify the incidence and duration of cytopenia independent of the existing model, CAR-HEMATOTOX, which is based on laboratory data at lymphodepletion. Thus, this newly developed post-CAR-T inflammation-dependent score is accurate and useful for predicting prolonged hematotoxicity.
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Affiliation(s)
- Naokazu Nakamura
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Tomoyasu Jo
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan.
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan; Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chisaki Mizumoto
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Miki Nagao
- Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan
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26
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Ko JS, Lee JH, Yoon DH, Suh CH, Chung SR, Choi YJ, Baek JH. CT Demonstration of Local Cytokine-Release Syndrome Involving the Head and Neck Following Chimeric Antigen Receptor T Cell Infusion Therapy. Korean J Radiol 2024; 25:399-402. [PMID: 38528698 PMCID: PMC10973737 DOI: 10.3348/kjr.2023.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Ji Su Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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27
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Hayashino K, Seike K, Fujiwara K, Kondo K, Matsubara C, Terao T, Kitamura W, Kamoi C, Fujiwara H, Asada N, Nishimori H, Ennishi D, Fujii K, Fujii N, Matsuoka KI, Maeda Y. Chimeric antigen receptor T-cell therapy after COVID-19 in refractory high-grade B-cell lymphoma. Int J Hematol 2024; 119:459-464. [PMID: 38349446 PMCID: PMC10960909 DOI: 10.1007/s12185-024-03711-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 03/24/2024]
Abstract
Although chimeric antigen receptor T-cell (CAR-T) therapies have dramatically improved the outcomes of relapsed/refractory B-cell malignancies, recipients suffer from severe humoral immunodeficiencies. Furthermore, patients with coronavirus disease 2019 (COVID-19) have a poor prognosis, as noted in several case reports of recipients who had COVID-19 before the infusion. We report the case of a 70-year-old woman who developed COVID-19 immediately before CAR-T therapy for high-grade B-cell lymphoma. She received Tixagevimab-Cilgavimab chemotherapy and radiation therapy but never achieved remission. She was transferred to our hospital for CAR-T therapy, but developed COVID-19. Her symptoms were mild and she was treated with long-term molnupiravir. On day 28 post-infection, lymphodepleting chemotherapy was restarted after a negative polymerase chain reaction (PCR) test was confirmed. The patient did not experience recurrence of COVID-19 symptoms or severe cytokine release syndrome. Based on the analysis and comparison of the previous reports with this case, we believe that CAR-T therapy should be postponed until a negative PCR test is confirmed. In addition, Tixagevimab-Cilgavimab and long term direct-acting antiviral agent treatment can be effective prophylaxis for severe COVID-19 and shortening the duration of infection.
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Affiliation(s)
- Kenta Hayashino
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Keisuke Seike
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan.
| | - Kanako Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Kaho Kondo
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Chisato Matsubara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Toshiki Terao
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Chihiro Kamoi
- Division of Blood Transfusion, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Daisuke Ennishi
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Keiko Fujii
- Division of Clinical Laboratory, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata, Okayama-shi, Okayama, Japan
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Perera N, Baidya S, Weber N, Mudie K, Butler J, Curley C, Henden A, Hunt S, Subramoniapillai E, Tey SK, Kennedy GA, Scott AP. Granulocyte transfusion supportive care for prolonged cytopenias post CD19 CAR T cell therapy. Transfusion 2024; 64:762-765. [PMID: 38593296 DOI: 10.1111/trf.17793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Nilu Perera
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | - Shoma Baidya
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Nicholas Weber
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kari Mudie
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jason Butler
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cameron Curley
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | - Andrea Henden
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Australia
- Translational Cancer Immunotherapy, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Stewart Hunt
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Elango Subramoniapillai
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Siok-Keen Tey
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
- Translational Cancer Immunotherapy, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Glen A Kennedy
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Ashleigh P Scott
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, St Lucia, Australia
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29
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Gurney M, Baranwal A, Rosenthal A, Kharfan-Dabaja MA, Kenderian SS, Lin Y, Shah MV. Features and Factors Associated With Myeloid Neoplasms After Chimeric Antigen Receptor T-Cell Therapy. JAMA Oncol 2024; 10:532-535. [PMID: 38386311 PMCID: PMC10884941 DOI: 10.1001/jamaoncol.2023.7182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024]
Abstract
This case-control study examines the incidence and risks of myeloid neoplasms in adults treated for B-cell lymphoproliferative disorders or multiple myeloma.
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Affiliation(s)
- Mark Gurney
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Anmol Baranwal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
- Cancer Centers of Southwest Oklahoma, Lawton
| | | | | | | | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
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30
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Gye A, Lourenco RDA, Goodall S. Discrete Event Simulation to Incorporate Infusion Wait-Time When Assessing Cost-Effectiveness of a Chimeric-Antigen Receptor T Cell Therapy. Value Health 2024; 27:415-424. [PMID: 38301961 DOI: 10.1016/j.jval.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The main objective was to use discrete event simulation to model the impact of wait-time, defined as the time between leukapheresis and chimeric antigen receptor (CAR-T) infusion, when assessing the cost-effectiveness of tisagenlecleucel in young patients with relapsed/refractory acute lymphoblastic leukemia. METHODS The movement of patients through the model was determined by parametric time-to-event distributions, with the competing risk of an event determining the costs and quality-adjusted life-years (QALYs) assigned. Cost-effectiveness was expressed using the incremental cost-effectiveness ratio (ICER) for tisagenlecleucel compared with chemotherapy over the lifetime. RESULTS The base case generated a total of 5.79 QALYs and $622 872 for tisagenlecleucel and 1.19 QALYs and $181 219 for blinatumomab, resulting in an ICER of $96 074 per QALY. An increase in mean CAR-T wait-time to 6.20 months reduced the benefit and costs of tisagenlecleucel to 2.78 QALYs and $294 478 because of fewer patients proceeding to infusion, reducing the ICER to $71 112 per QALY. Alternatively, when the cost of tisagenlecleucel was assigned pre-infusion in sensitivity analysis, the ICER increased with increasing wait-time. CONCLUSIONS Under a payment arrangement where CAR-T cost is incurred post-infusion, the loss of benefit to patients is not reflected in the ICER. This may be misguiding to decision makers, where cost-effectiveness ratios are used to guide resource allocation. discrete event simulation is an important tool for economic modeling of CAR-T as it is amenable to capturing the impact of wait-time, facilitating better understanding of factors affecting service delivery and consequently informed decision making to deliver faster access to CAR-T for patients.
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Affiliation(s)
- Amy Gye
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
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31
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Zhang T, Tai Z, Miao F, Zhang X, Li J, Zhu Q, Wei H, Chen Z. Adoptive cell therapy for solid tumors beyond CAR-T: Current challenges and emerging therapeutic advances. J Control Release 2024; 368:372-396. [PMID: 38408567 DOI: 10.1016/j.jconrel.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 02/28/2024]
Abstract
Adoptive cellular immunotherapy using immune cells expressing chimeric antigen receptors (CARs) is a highly specific anti-tumor immunotherapy that has shown promise in the treatment of hematological malignancies. However, there has been a slow progress toward the treatment of solid tumors owing to the complex tumor microenvironment that affects the localization and killing ability of the CAR cells. Solid tumors with a strong immunosuppressive microenvironment and complex vascular system are unaffected by CAR cell infiltration and attack. To improve their efficacy toward solid tumors, CAR cells have been modified and upgraded by "decorating" and "pruning". This review focuses on the structure and function of CARs, the immune cells that can be engineered by CARs and the transformation strategies to overcome solid tumors, with a view to broadening ideas for the better application of CAR cell therapy for the treatment of solid tumors.
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Affiliation(s)
- Tingrui Zhang
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Medical Guarantee Center, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China; School of Medicine, Shanghai University, Shanghai 200444, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China; Department of Pharmacy, First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Fengze Miao
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China
| | - Jiadong Li
- School of Medicine, Shanghai University, Shanghai 200444, China
| | - Quangang Zhu
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China
| | - Hua Wei
- Medical Guarantee Center, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China.
| | - Zhongjian Chen
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; School of Medicine, Shanghai University, Shanghai 200444, China; Shanghai Engineering Research Center for Topical Chinese Medicine, Shanghai 200443, China.
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32
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Brown CE, Hibbard JC, Alizadeh D, Blanchard MS, Natri HM, Wang D, Ostberg JR, Aguilar B, Wagner JR, Paul JA, Starr R, Wong RA, Chen W, Shulkin N, Aftabizadeh M, Filippov A, Chaudhry A, Ressler JA, Kilpatrick J, Myers-McNamara P, Chen M, Wang LD, Rockne RC, Georges J, Portnow J, Barish ME, D'Apuzzo M, Banovich NE, Forman SJ, Badie B. Locoregional delivery of IL-13Rα2-targeting CAR-T cells in recurrent high-grade glioma: a phase 1 trial. Nat Med 2024; 30:1001-1012. [PMID: 38454126 PMCID: PMC11031404 DOI: 10.1038/s41591-024-02875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Chimeric antigen receptor T cell (CAR-T) therapy is an emerging strategy to improve treatment outcomes for recurrent high-grade glioma, a cancer that responds poorly to current therapies. Here we report a completed phase I trial evaluating IL-13Rα2-targeted CAR-T cells in 65 patients with recurrent high-grade glioma, the majority being recurrent glioblastoma (rGBM). Primary objectives were safety and feasibility, maximum tolerated dose/maximum feasible dose and a recommended phase 2 dose plan. Secondary objectives included overall survival, disease response, cytokine dynamics and tumor immune contexture biomarkers. This trial evolved to evaluate three routes of locoregional T cell administration (intratumoral (ICT), intraventricular (ICV) and dual ICT/ICV) and two manufacturing platforms, culminating in arm 5, which utilized dual ICT/ICV delivery and an optimized manufacturing process. Locoregional CAR-T cell administration was feasible and well tolerated, and as there were no dose-limiting toxicities across all arms, a maximum tolerated dose was not determined. Probable treatment-related grade 3+ toxicities were one grade 3 encephalopathy and one grade 3 ataxia. A clinical maximum feasible dose of 200 × 106 CAR-T cells per infusion cycle was achieved for arm 5; however, other arms either did not test or achieve this dose due to manufacturing feasibility. A recommended phase 2 dose will be refined in future studies based on data from this trial. Stable disease or better was achieved in 50% (29/58) of patients, with two partial responses, one complete response and a second complete response after additional CAR-T cycles off protocol. For rGBM, median overall survival for all patients was 7.7 months and for arm 5 was 10.2 months. Central nervous system increases in inflammatory cytokines, including IFNγ, CXCL9 and CXCL10, were associated with CAR-T cell administration and bioactivity. Pretreatment intratumoral CD3 T cell levels were positively associated with survival. These findings demonstrate that locoregional IL-13Rα2-targeted CAR-T therapy is safe with promising clinical activity in a subset of patients. ClinicalTrials.gov Identifier: NCT02208362 .
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Affiliation(s)
- Christine E Brown
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA.
| | - Jonathan C Hibbard
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Darya Alizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - M Suzette Blanchard
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Heini M Natri
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Dongrui Wang
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
- Bone Marrow Transplantation Center, the First Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
| | - Julie R Ostberg
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Brenda Aguilar
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jamie R Wagner
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jinny A Paul
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Renate Starr
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Robyn A Wong
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Wuyang Chen
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Noah Shulkin
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Maryam Aftabizadeh
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Aleksandr Filippov
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie A Ressler
- Department of Diagnostic Radiology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Julie Kilpatrick
- Department of Clinical Research, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Paige Myers-McNamara
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Mike Chen
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Leo D Wang
- Departments of Immuno-Oncology and Pediatrics, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Russell C Rockne
- Department of Computational and Quantitative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Joseph Georges
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Jana Portnow
- Department of Medical Oncology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Michael E Barish
- Department of Stem Cell Biology & Regenerative Medicine, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | | | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation (T Cell Therapeutics Research Laboratories), City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Department of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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33
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Bansal R, Vergidis P, Tosh PK, Wilson J, Hathcock M, Khurana A, Bennani NN, Paludo J, Villasboas JC, Wang Y, Ansell SM, Johnston PB, Freeman C, Lin Y. Serial Evaluation of Preimmunization Antibody Titers in Lymphoma Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:455.e1-455.e7. [PMID: 38346643 DOI: 10.1016/j.jtct.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/02/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
Antibody titers and the potential need for immunization have not been formally studied in recipients of chimeric antigen receptor T cell therapy (CAR-T). Prior studies have shown that CD19-targeted CAR-T can induce persistent B cell aplasia but preserve plasma cells for humoral response. Aiming to assess the immune repertoire and antibody titer status of CAR-T recipients, we conducted a retrospective study of immune cell recovery and antibody titers to vaccines in anti-CD19 CAR-T recipients at Mayo Clinic, Rochester. In our cohort of 95 CAR-T recipients, almost one-half had low CD4 T and B cell counts prior to CAR-T that remained persistently low post-CAR-T. Prior to CAR-T, the seronegative rate was lowest for tetanus and highest for pneumococcus irrespective of prior transplantation status (within 2 years of CAR-T). At 3 months post-CAR-T, overall seronegativity rates were similar to pre-CAR-T rates for the prior transplantation and no prior transplantation groups. For patients who received IVIG, loss of seropositivity was seen for hepatitis A (1 of 7; 14%). No seroconversion was noted for pneumococcus. For patients who did not receive IVIG, loss of seropositivity was seen for pneumococcus (2 of 5; 40%) and hepatitis A (1 of 4; 25%). CAR-T recipients commonly experience T cell and B cell lymphopenia and might not have adequate antibody titers against vaccine-preventable diseases despite IVIG supplementation. Loss of antibody titers post-CAR-T is possible, highlighting the need for revaccination. Additional studies with long-term follow-up are needed to inform the optimal timing of immunization post-CAR-T.
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Affiliation(s)
- Radhika Bansal
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Pritish K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - John Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Catherine Freeman
- Division of Asthma, Allergy and Clinical Immunology, Mayo Clinic, Scottsdale, Arizona
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, Minnesota.
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34
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Galli E, Limongiello MA, Metafuni E, Giammarco S, Fresa A, Piccirillo N, Bianchi M, Laurenti L, Sorà F, Chiusolo P, Sica S. Unselected donor-derived hematopoietic stem cells boost for Chimeric Antigen Receptor T-cell associated hematotoxicity. Am J Hematol 2024; 99:751-754. [PMID: 38247313 DOI: 10.1002/ajh.27208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
Hematological toxicity following Chimeric Antigen Receptor-T therapy in a patient with a prior allogeneic stem cell transplantation was resolved by the infusion of unselected donor-derived stem cell boost. Due to the donor's lymphocytes, the patient experienced a well-controlled flare-up of acute graft versus host disease.
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Affiliation(s)
- Eugenio Galli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Assunta Limongiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Fresa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Piccirillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Sorà
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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35
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Elgohary G, Yang Y, Gergis M, Yi D, Gergis U. Chimeric Antigen Receptor T - Cell Therapy for Large B-Cell Lymphoma Patients with Central Nervous System Involvement, a Systematic Review and Meta-analysis. Clin Lymphoma Myeloma Leuk 2024; 24:e142-e151. [PMID: 38267353 DOI: 10.1016/j.clml.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
Chimeric Antigen Receptor T-cell (CAR T-cell) therapy is an effective treatment for relapsed/refractory (R/R) large B cell lymphoma (LBCL). However, patients with central nervous system (CNS) lymphoma were excluded in most of the CAR T-cell therapy trials. This meta-analysis assesses the efficacy with CAR T-cell therapy in LBCL patients with CNS involvement. Two reviewers independently searched PubMed and Cochrane Library to identify all published literature associated with United States Food and Drug Administration approved CAR T-cell therapies for LBCL. Patients with CNS LBCL were included. Meta-analysis of proportion was performed to evaluate the overall response (ORR), complete response (CR) for efficacy, and cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome for safety assessment. Nineteen studies were qualified for inclusion with 141 CNS LBCL patients. The ORR and CR rates were 61% and 55% respectively. The median overall survival (OS) was 8.8 months, and the median progression free survival (PFS) was 4.4 months. Severe immune effector cell-associated neurotoxicity syndrome (grade≥3) were reported in 25% (32/130) patients and severe cytokine release syndrome (grade≥3) were found in 10% (13/124) of the patients. The safety and efficacy of CAR T-cell therapy in CNS LBCL patients appears comparable to patients without CNS involvement.
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Affiliation(s)
| | - Yang Yang
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Usama Gergis
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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36
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Barata A, Dhawale T, Newcomb RA, Amonoo HL, Nelson AM, Yang D, Karpinski K, Holmbeck K, Farnam E, Frigault M, Johnson PC, El-Jawahri A. Quality of Life and Prognostic Awareness in Caregivers of Patients Receiving Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther 2024; 30:452.e1-452.e11. [PMID: 38242441 DOI: 10.1016/j.jtct.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/19/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
Caregivers of patients undergoing chimeric antigen receptor T cell therapy (CAR-T) play a critical role during treatment, yet their experience remains largely unaddressed. We aimed to longitudinally describe quality of life (QoL) and psychological distress, as well as prognostic awareness, in caregivers and explore the association of prognosis awareness with baseline psychological distress. We conducted a longitudinal study of caregivers of patients undergoing CAR-T and examined QoL (CAReGiverOncology QoL questionnaire) and psychological distress (Hospital Anxiety and Depression Scale) prior to CAR-T (baseline) and at days 7, 30, 90, and 180 post-CAR-T. At baseline, caregivers and patients completed the Prognostic Awareness Impact Scale, which examines cognitive understanding of prognosis, emotional coping with prognosis, and adaptive response (ie, capacity to use prognostic awareness to inform life decisions). We enrolled 58% (69 of 120) of eligible caregivers. Caregivers reported QoL impairments that did not change over time (B = 0.09; P = .452). The rates of clinically significant depression and anxiety symptoms were 47.7% and 20.0%, respectively, at baseline, and 39.1% and 17.4% at 180 days. One-third (32%) of the caregivers and patients reported that their oncologist said the cancer is curable. Caregivers' greater emotional coping with prognosis was associated with fewer symptoms of anxiety (B = -.17; P < .001) and depression (B = -.02; P < .001). Cognitive understanding of prognosis and adaptive response were not associated with psychological distress. Caregivers reported QoL impairments throughout the study period. A substantial proportion of caregivers experienced psychological distress and reported misperceptions about the prognosis, highlighting the need for supportive care interventions.
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Affiliation(s)
- Anna Barata
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Tejaswini Dhawale
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hermioni L Amonoo
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ashley M Nelson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Daniel Yang
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Karpinski
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine Holmbeck
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Emelia Farnam
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Matt Frigault
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Wesson W, Ahmed N, Rashid A, Tabak C, Logan E, Marchena-Burgos J, Nelson M, Davis JA, McGann M, Shune L, Hoffmann M, Abdallah AO, Hashmi H. Safety and efficacy of eltrombopag in patients with post-CAR T cytopenias. Eur J Haematol 2024; 112:538-546. [PMID: 38044594 DOI: 10.1111/ejh.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND While chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment outcomes of relapsed/refractory hematological malignancies, this therapy is associated with post-treatment cytopenias, which can pose a challenge to its safe administration. This study describes the management of post-CAR T cytopenias using the thrombopoietin mimetic eltrombopag. METHODS This retrospective analysis included adult patients with lymphoma or myeloma who received CAR T-cell therapy at two academic medical centers. Eltrombopag was initiated for patients who had persistent high-grade leukopenia and/or thrombocytopenia beyond 21 days post-CAR T infusion. Risk factors and outcomes were assessed and compared for patients who did or did not receive eltrombopag. RESULTS Among the 185 patients analyzed, a majority (88%) experienced thrombocytopenia or leukopenia at day +30 post-CAR T infusion. A total of 42 patients met the criteria for eltrombopag treatment and initiated therapy. Patients who received eltrombopag were more likely to have pre-existing cytopenias at lymphodepletion, receive bridging therapy, experience an infection, or require intensive care. Recovery from cytopenias occurred within 180 days for a majority (94%) of patients. CONCLUSIONS The use of eltrombopag for post-CAR T leukopenia and thrombocytopenia was considered safe without any significant toxicities. The use of eltrombopag for post-CAR T cytopenias might be effective in a high-risk patient population but requires further study.
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Affiliation(s)
- William Wesson
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Aliya Rashid
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Carine Tabak
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Emerson Logan
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Jose Marchena-Burgos
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Maggie Nelson
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - James A Davis
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mary McGann
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Leyla Shune
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Marc Hoffmann
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Al-Ola Abdallah
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, Kansas, USA
| | - Hamza Hashmi
- Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
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Fang J, Zhou F. BCMA-targeting chimeric antigen receptor T cell therapy for relapsed and/or refractory multiple myeloma. Ann Hematol 2024; 103:1069-1083. [PMID: 37704875 DOI: 10.1007/s00277-023-05444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
Recently, many new therapies have improved the outcomes of patients with relapsed and/or refractory multiple myeloma (RRMM). Nevertheless, recurrence is still unavoidable, and better treatment choices for RRMM are urgently needed. The clinical success of Chimera antigen receptor (CAR) T cell therapy in many hematological diseases, including leukemia and lymphoma, has drawn considerable attention to RRMM. As CAR T cell therapy continues to mature and challenge traditional therapies, it is gradually changing the treatment paradigm for MM patients. The B cell maturation antigen (BCMA), expressed in malignant plasma cells but not normal ones, is an ideal target for MM treatment, due to its high expression. The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) has approved two BCMA-targeting CAR T cell products, idecabtagene vicleucel (Ide-cel) and ciltacabtagene autoleucel (Cilta-cel), for use in RRMM. In this review, we focus on data from RRMM patients involved in clinical trials of Ide-cel and Cilta-cel and discuss the present situation and future direction of CAR T cell therapy for this condition.
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Affiliation(s)
- Jiamin Fang
- Department of Hematology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430072, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, No.169 Donghu Road, Wuhan, 430072, China.
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Zhou R, Wu ST, Yazdanifar M, Williams C, Sanders A, Brouwer C, Maher J, Mukherjee P. Mucin-1-Targeted Chimeric Antigen Receptor T Cells Are Effective and Safe in Controlling Solid Tumors in Immunocompetent Host. J Immunother 2024; 47:77-88. [PMID: 38270462 PMCID: PMC10913860 DOI: 10.1097/cji.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
The chimeric antigen receptor (CAR) T-cell therapy in solid epithelial tumors has been explored, however, with limited success. As much of the preclinical work has relied on xenograft models in immunocompromised animals, the immune-related efficacies and toxicities may have been missed. In this study, we engineered syngeneic murine CAR T cells targeting the tumor form of human mucin-1 (tMUC1) and tested the MUC1 CAR T cells' efficacy and toxicity in the immunocompetent human MUC1-expressing mouse models. The MUC1 CAR T cells significantly eliminated murine pancreatic and breast cancer cell lines in vitro. In vivo, MUC1 CAR T cells significantly slowed the mammary gland tumor progression in the spontaneous PyVMT×MUC1.Tg (MMT) mice, prevented lung metastasis, and prolonged survival. Most importantly, there was minimal short or long-term toxicity with acceptable levels of transient liver toxicity but no kidney toxicity. In addition, the mice did not show any signs of weight loss or other behavioral changes with the treatment. We also report that a single dose of MUC1 CAR T-cell treatment modestly reduced the pancreatic tumor burden in a syngeneic orthotopic model of pancreatic ductal adenocarcinoma given at late stage of an established tumor. Taken together, these findings suggested the further development of tMUC1-targeted CAR T cells as an effective and relatively safe treatment modality for various tMUC1-expressing solid tumors.
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Affiliation(s)
- Ru Zhou
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Shu-ta Wu
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Medpace, Irving, TX
| | - Mahboubeh Yazdanifar
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Adaptive Biotechnologies, South San Francisco, CA
| | - Chandra Williams
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
- Pfizer, Cambridge, MA
| | - Alexa Sanders
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - Cory Brouwer
- Department of Bioinformatics, University of North Carolina at Charlotte, Charlotte, NC
| | - John Maher
- King’s College London, School of Cancer and Pharmaceutical Sciences, Guy’s Cancer Centre, London, UK
| | - Pinku Mukherjee
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC
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Greenbaum U, Yehudai-Ofir D, Beyar Katz O, Shargian L, Jacoby E, Grisaru S, Zuckerman T, Ram R, Avigdor A. [CHIMERIC ANTIGEN RECEPTOR T CELLS (CAR-T CELLS) THERAPY FOR B-CELL HEMATOLOGICAL MALIGNANCIES - FROM THE ISRAELI SOCIETY OF HEMATOLOGY AND TRANSFUSION MEDICINE]. Harefuah 2024; 163:236-243. [PMID: 38616634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Using immunotherapy to fight cancer, and specifically, the use of engineered T-cells expressing a chimeric receptor against an antigen found on malignant cells (chimeric antigen receptor, CAR-T cells) constitutes a significant breakthrough in the treatment of the disease. In recent years, several CAR-T therapies have been approved in Europe and the USA, and some are already approved and funded through the national health basket in Israel, for the indications of diffuse large B-cell lymphoma, mantle cell lymphoma and B-cell acute lymphoblastic leukemia, after the failure of at least two lines of treatment. The treatment with CAR-T cells achieves prolonged remissions and even long-term cure of patients who had a very poor prognosis. However, the treatment involves significant side effects, and requires specific expertise in the management of patients both during the period of preparation for cell transplantation, and following the treatment. During the immediate post-infusion period, the most common adverse reactions are cytokine release syndrome (CRS) which stems from the activation of the immune system, and neurological toxicity that can accompany CRS. These effects require close monitoring, grading their severity, and providing anti-cytokine therapy or steroid therapy until control of symptoms is achieved. Later effects can be persistent cytopenias, immune over-activation, and prolonged immune deficiency. Treatments for additional indications and new CAR-T constructs are being developed and will allow more effective and safer treatment. This article summarizes the principles for CAR-T administration that, as currently provided in Israel, include the short- and long-term follow-up of the patients.
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Affiliation(s)
- Uri Greenbaum
- Hematology Department, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Dana Yehudai-Ofir
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofrat Beyar Katz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Liat Shargian
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Jacoby
- Division of Pediatric Hematology and Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Grisaru
- Bone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and the Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ron Ram
- BMT and Cellular Therapy Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Abraham Avigdor
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv
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Colomes A, Ellouze S, Fontaine JP, Thieblemont C, Peyrony O. Emergency department visits after chimeric antigen receptor T cell therapy: a retrospective observational study. Eur J Emerg Med 2024; 31:155-157. [PMID: 38416588 DOI: 10.1097/mej.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
| | | | | | - Catherine Thieblemont
- Onco-hematology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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Parikh RR, Milgrom SA, Campbell BA. Pushing the CART to the Finish Line: Integrating Radiation Therapy Into Chimeric Antigen Receptor T-Cell Therapy Programs to Improve Outcomes for Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2024; 118:1152-1158. [PMID: 38492961 DOI: 10.1016/j.ijrobp.2023.03.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 03/18/2024]
Affiliation(s)
- Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
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Ren CX, Zhao L, Chen XX, Tian Y, Zhao K. [Construction and Optimization of CD19 Chimeric Antigen Receptor T Cells Derived from C57BL/6J Mice]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2024; 32:595-602. [PMID: 38660872 DOI: 10.19746/j.cnki.issn.1009-2137.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To explore the stimulation conditions, optimal culture time and infection time of C57BL/6J mice CD3+ T cells in vitro, so as to improve the infection efficiency of CD19 chimeric antigen receptor T cells (mCD19 CAR-T). METHODS Purified C57BL/6J mice CD3+ T cells were cultured in anti-CD3/CD28 coated, anti-CD3 coated+soluble anti-CD28 and anti-CD3 coated, respectively. The cells were stimulated in above three conditions for 12 h and 24 h, following with 24 h, 48 h and 72 h incubation and then the number of cell clones was recorded. C57BL/6J mice CD3+ T cells were stimulated for 12 h, 24 h, and 36 h under the above three conditions, then interleukin (IL)-2 (100 U/ml) was added. The number of cell clones was recorded under microscope at 24 h, 48 h, and 72 h of culture. After 24 h of stimulation, CD3+ T cells derived from C57BL/6J mice were infected with retrovirus for 48 h to establish mCD19 CAR-T cells, and the percentage of GFP+ CAR-T cells was detected by flow cytometry. RESULTS The infection efficiency of mCD19 CAR-T cells derived from C57BL/6J mice was only 5.23% under the optimized conditions of mCD19 CAR-T cells derived from BALB/c mice. The number of clones of C57BL/6J mice CD3+ T cells was the highest in anti-CD3 coated+soluble anti-CD28 group after stimulated for 24 h and followed cultured for 48 h. After 24 hours of stimulation under the above conditions and 48 hours of culture with IL-2, the number of T cell proliferating clones in the anti-CD3 coated+soluble anti-CD28 group was significantly increased compared with the same group without IL-2, and the infection efficiency of CAR-T cells in this group reached 17.63%±4.17%. CONCLUSION The optimal conditions for constructing CAR-T cells from C57BL/6J mice CD3+ T cells are different from those of BABL/c mice. T cells stimulated by anti-CD3 coated+soluble anti-CD28+IL-2 can obtain mCD19 CAR-T cells with the highest efficiency after retrovirus infection.
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Affiliation(s)
- Chun-Xiao Ren
- Blood Disease Institute, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cell, Xuzhou 221000, Jiangsu Province, China
| | - Li Zhao
- Blood Disease Institute, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cell, Xuzhou 221000, Jiangsu Province, China
| | - Xian-Xian Chen
- Blood Disease Institute, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cell, Xuzhou 221000, Jiangsu Province, China
| | - Yu Tian
- Blood Disease Institute, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cell, Xuzhou 221000, Jiangsu Province, China
| | - Kai Zhao
- Blood Disease Institute, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
- Jiangsu Provincial Key Laboratory of Bone Marrow Stem Cell, Xuzhou 221000, Jiangsu Province, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China.E-mail:
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Scourfield L, Pirani T, Singh N, Saha R, Kuhnl A, Sanderson R, Metaxa V. An update on ICU outcomes in patients after CAR T therapy: A four-year tertiary UK centre experience. J Crit Care 2024; 80:154511. [PMID: 38157684 DOI: 10.1016/j.jcrc.2023.154511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Lily Scourfield
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom; Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Tasneem Pirani
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Neeraj Singh
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Rohit Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robin Sanderson
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Ahmadi P, Ghandili S, Jakobs F, Konnopka C, Morgner-Miehlke A, Kröger N, Ayuk F. Cost analysis of patients undergoing allogeneic stem cell transplantation or chimeric antigen receptor T-cell therapy in relapsed or refractory diffuse large B-cell lymphoma from a German healthcare payer perspective. Bone Marrow Transplant 2024; 59:572-574. [PMID: 38321270 PMCID: PMC10994829 DOI: 10.1038/s41409-024-02228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
MESH Headings
- Humans
- Receptors, Chimeric Antigen
- Lymphoma, Non-Hodgkin
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Immunotherapy, Adoptive
- Hematopoietic Stem Cell Transplantation
- Costs and Cost Analysis
- Delivery of Health Care
- Receptors, Antigen, T-Cell
- Antigens, CD19
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Affiliation(s)
- P Ahmadi
- Controlling University Medical Center Hamburg, Hamburg, Germany
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Ghandili
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Jakobs
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - C Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Morgner-Miehlke
- Center for Oncology, University Medical Center Hamburg, Hamburg, Germany
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Pu Y, Zhao Y, Qi Y, Liu Y, Zhang M, Xiao X, Lyu H, Meng J, Zhu H, Xu K, Han W, Zhao M. Multi-centers experience using therapeutic plasma exchange for corticosteroid/tocilizumab-refractory cytokine release syndrome following CAR-T therapy. Int Immunopharmacol 2024; 130:111761. [PMID: 38422769 DOI: 10.1016/j.intimp.2024.111761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
The chimeric antigen receptor T (CAR-T) cell therapy significantly enhances the prognosis of various hematologic malignancies; however, the systemic expansion of CAR-T cells also gives rise to severe cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Despite the successful application of corticosteroids and tocilizumab in alleviating severe CRS in most patients, there are still individuals who experience life-threatening CRS without responding to the aforementioned therapies. In our retrospective cohort, we conducted an analysis of clinical and laboratory parameters, including inflammatory cytokines, in 17 patients from three centers who underwent therapeutic plasma exchange (TPE) for refractory CRS with or without ICANS following CAR-T products treatment. Our findings demonstrate a significant improvement in both clinical symptoms and laboratory parameters subsequent to TPE treatment. The rapid decrease in temperature and levels of inflammatory indexes indicates the remarkable scavenging efficacy of TPE against cytokine storm following CAR-T therapy. In conclusion, TPE may serve as a valuable and safe adjunct to corticosteroids and tocilizumab in the management of severe CRS resulting from CAR-T cell infusion. We eagerly await further prospective studies to validate this finding.
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Affiliation(s)
- Yedi Pu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Yifan Zhao
- The First Central Clinical College of Tianjin Medical University, Tianjin 300380, China
| | - Yuekun Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Yang Liu
- Department of Bio-therapeutic, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Meng Zhang
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Hairong Lyu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Juanxia Meng
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Haibo Zhu
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China.
| | - Weidong Han
- Department of Bio-therapeutic, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin 300380, China.
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Hughes SE, McMullan C, Aiyegbusi OL, Shaw K, Kinsella F, Ferguson P, Khatsuria F, Burns D, Pyatt L, Ansell J, Chakera E, Richardson-Abraham J, Denniston AK, Davies EH, Craddock C, Calvert M. Protocol for a mixed-methods study to develop and feasibility test a digital system for the capture of patient-reported outcomes (PROs) in patients receiving chimeric antigen receptor T-cell (CAR-T) therapies (the PRO-CAR-T study). BMJ Open 2024; 14:e085392. [PMID: 38553074 PMCID: PMC10982800 DOI: 10.1136/bmjopen-2024-085392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Chimeric antigen receptor (CAR) T-cell therapies are novel, potentially curative therapies for haematological malignancies. CAR T-cell therapies are associated with severe toxicities, meaning patients require monitoring during acute and postacute treatment phases. Electronic patient-reported outcomes (ePROs), self-reports of health status provided via online questionnaires, can complement clinician observation with potential to improve patient outcomes. This study will develop and evaluate feasibility of a new ePRO system for CAR-T patients in routine care. METHODS AND ANALYSIS Multiphase, mixed-methods study involving multiple stakeholder groups (patients, family members, carers, clinicians, academics/researchers and policy-makers). The intervention development phase comprises a Delphi study to select PRO measures for the digital system, a codesign workshop and consensus meetings to establish thresholds for notifications to the clinical team if a patient reports severe symptoms or side effects. Usability testing will evaluate how users interact with the digital system and, lastly, we will evaluate ePRO system feasibility with 30 CAR-T patients (adults aged 18+ years) when used in addition to usual care. Feasibility study participants will use the ePRO system to submit self-reports of symptoms, treatment tolerability and quality of life at specific time points. The CAR-T clinical team will respond to system notifications triggered by patients' submitted responses with actions in line with standard clinical practice. Feasibility measures will be collected at prespecified time points following CAR T-cell infusion. A qualitative substudy involving patients and clinical team members will explore acceptability of the ePRO system. ETHICS AND DISSEMINATION Favourable ethical opinion was granted by the Health and Social Care Research Ethics Committee B(HSC REC B) (ref: 23/NI/0104) on 28 September 2023. Findings will be submitted for publication in high-quality, peer-reviewed journals. Summaries of results, codeveloped with the Blood and Transplant Research Unit Patient and Public Involvement and Engagement group, will be disseminated to all interested groups. TRIAL REGISTRATION NUMBER ISCTRN11232653.
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Affiliation(s)
- Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Karen Shaw
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
| | - Francesca Kinsella
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Paul Ferguson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Foram Khatsuria
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - David Burns
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | - Alastair K Denniston
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Opthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Charles Craddock
- University of Birmingham, Birmingham, UK
- Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute of Health and Care Research (NIHR) Blood and Transplant Research Unit (BTRU) in Precision Cellular Therapeutics, Birmingham, UK
- NIHR Applied Research Collaboration (ARC) West Midlands, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
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Kashyap D, Salman H. Targeting Interleukin-13 Receptor α2 and EphA2 in Aggressive Breast Cancer Subtypes with Special References to Chimeric Antigen Receptor T-Cell Therapy. Int J Mol Sci 2024; 25:3780. [PMID: 38612592 PMCID: PMC11011362 DOI: 10.3390/ijms25073780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer (BCA) remains the leading cause of cancer-related mortality among women worldwide. This review delves into the therapeutic challenges of BCA, emphasizing the roles of interleukin-13 receptor α2 (IL-13Rα2) and erythropoietin-producing hepatocellular receptor A2 (EphA2) in tumor progression and resistance. Highlighting their overexpression in BCA, particularly in aggressive subtypes, such as Her-2-enriched and triple-negative breast cancer (TNBC), we discuss the potential of these receptors as targets for chimeric antigen receptor T-cell (CAR-T) therapies. We examine the structural and functional roles of IL-13Rα2 and EphA2, their pathological significance in BCA, and the promising therapeutic avenues their targeting presents. With an in-depth analysis of current immunotherapeutic strategies, including the limitations of existing treatments and the potential of dual antigen-targeting CAR T-cell therapies, this review aims to summarize potential future novel, more effective therapeutic interventions for BCA. Through a thorough examination of preclinical and clinical studies, it underlines the urgent need for targeted therapies in combating the high mortality rates associated with Her-2-enriched and TNBC subtypes and discusses the potential role of IL-13Rα2 and EphA2 as promising candidates for the development of CAR T-cell therapies.
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Affiliation(s)
| | - Huda Salman
- Brown Center for Immunotherapy, Melvin and Bren Simon Comprehensive Cancer Center, Division of Hematology and Oncology, School of Medicine, Indiana University, Indianapolis, IN 46202, USA;
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García-García L, G. Sánchez E, Ivanova M, Pastora K, Alcántara-Sánchez C, García-Martínez J, Martín-Antonio B, Ramírez M, González-Murillo Á. Choosing T-cell sources determines CAR-T cell activity in neuroblastoma. Front Immunol 2024; 15:1375833. [PMID: 38601159 PMCID: PMC11004344 DOI: 10.3389/fimmu.2024.1375833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The clinical success of chimeric antigen receptor-modified T cells (CAR-T cells) for hematological malignancies has not been reproduced for solid tumors, partly due to the lack of cancer-type specific antigens. In this work, we used a novel combinatorial approach consisting of a versatile anti-FITC CAR-T effector cells plus an FITC-conjugated neuroblastoma (NB)-targeting linker, an FITC-conjugated monoclonal antibody (Dinutuximab) that recognizes GD2. Methods We compared cord blood (CB), and CD45RA-enriched peripheral blood leukapheresis product (45RA) as allogeneic sources of T cells, using peripheral blood (PB) as a control to choose the best condition for anti-FITC CAR-T production. Cells were manufactured under two cytokine conditions (IL-2 versus IL-7+IL-15+IL-21) with or without CD3/CD28 stimulation. Immune phenotype, vector copy number, and genomic integrity of the final products were determined for cell characterization and quality control assessment. Functionality and antitumor capacity of CB/45RA-derived anti-FITC CAR-T cells were analyzed in co-culture with different anti-GD2-FITC labeled NB cell lines. Results The IL-7+IL-15+IL-21 cocktail, in addition to co-stimulation signals, resulted in a favorable cell proliferation rate and maintained less differentiated immune phenotypes in both CB and 45RA T cells. Therefore, it was used for CAR-T cell manufacturing and further characterization. CB and CD45RA-derived anti-FITC CAR-T cells cultured with IL-7+IL-15+IL-21 retained a predominantly naïve phenotype compared with controls. In the presence of the NB-FITC targeting, CD4+ CB-derived anti-FITC CAR-T cells showed the highest values of co-stimulatory receptors OX40 and 4-1BB, and CD8+ CAR-T cells exhibited high levels of PD-1 and 4-1BB and low levels of TIM3 and OX40, compared with CAR-T cells form the other sources studied. CB-derived anti-FITC CAR-T cells released the highest amounts of cytokines (IFN-γ and TNF-α) into co-culture supernatants. The viability of NB target cells decreased to 30% when co-cultured with CB-derived CAR-T cells during 48h. Conclusion CB and 45RA-derived T cells may be used as allogeneic sources of T cells to produce CAR-T cells. Moreover, ex vivo culture with IL-7+IL-15+IL-21 could favor CAR-T products with a longer persistence in the host. Our strategy may complement the current use of Dinutuximab in treating NB through its combination with a targeted CAR-T cell approach.
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Affiliation(s)
- Lorena García-García
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena G. Sánchez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Mariya Ivanova
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Keren Pastora
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Cristina Alcántara-Sánchez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jorge García-Martínez
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
| | - Beatriz Martín-Antonio
- Department of Experimental Hematology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | - Manuel Ramírez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
| | - África González-Murillo
- Department of Pediatric Hematology and Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Advanced Therapies Unit, Fundación Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Department of Progenitor and Cell Therapy Research Group, La Princesa Institute of Health Research, Madrid, Spain
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Flora C, Olesnavich M, Zuo Y, Sandford E, Madhukar R, Rozwadowski M, Sugur K, Ly A, Canbaz AA, Shedeck A, Li G, Geer MJ, Yanik GA, Ghosh M, Frame DG, Bonifant CL, Jain T, Knight JS, Choi SW, Tewari M. Longitudinal plasma proteomics in CAR T-cell therapy patients implicates neutrophils and NETosis in the genesis of CRS. Blood Adv 2024; 8:1422-1426. [PMID: 38266157 PMCID: PMC10950819 DOI: 10.1182/bloodadvances.2023010728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Christopher Flora
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Mary Olesnavich
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Yu Zuo
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Erin Sandford
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Rashmi Madhukar
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Michelle Rozwadowski
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
| | - Kavya Sugur
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Andrew Ly
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ata Alpay Canbaz
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Audra Shedeck
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gen Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Marcus J. Geer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - Gregory A. Yanik
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
| | - Monalisa Ghosh
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
| | - David G. Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Challice L. Bonifant
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tania Jain
- Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jason S. Knight
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Sung Won Choi
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University of Michigan, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | - Muneesh Tewari
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
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