1
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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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2
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Kuhnl A, Roddie C, Kirkwood AA, Chaganti S, Norman J, Lugthart S, Osborne W, Gibb A, Gonzalez Arias C, Latif A, Uttenthal B, Seymour F, Jones C, Springell D, Brady JL, Illidge T, Stevens A, Alexander E, Hawley L, O'Rourke N, Bedi C, Prestwich R, Frew J, Burns D, O'Reilly M, Sanderson R, Sivabalasingham S, Mikhaeel NG. Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK. Br J Haematol 2024. [PMID: 38594876 DOI: 10.1111/bjh.19453] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/07/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - S Chaganti
- Queen Elizabeth Hospital, Birmingham, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - S Lugthart
- University Hospitals Bristol and Weston, Bristol, UK
| | - W Osborne
- Freeman Hospital, Newcastle, UK
- Newcastle University, Newcastle, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | | | - A Latif
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - D Springell
- University College London Hospitals, London, UK
| | - J L Brady
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T Illidge
- Cancer Sciences, University of Manchester Christie NHS Trust, Manchester NIHR BRC, Manchester, UK
| | - A Stevens
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - L Hawley
- University Hospitals Bristol and Weston, Bristol, UK
| | - N O'Rourke
- Queen Elizabeth University Hospital, Glasgow, UK
| | - C Bedi
- Western General Hospital, Edinburgh, UK
| | | | - J Frew
- Freeman Hospital, Newcastle, UK
| | - D Burns
- Queen Elizabeth Hospital, Birmingham, UK
| | - M O'Reilly
- University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | | | - N G Mikhaeel
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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3
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Bourlon C, Roddie C, Menne T, Norman J, O'Reilly M, Gibb A, Besley C, Chaganti S, Arias CG, Jones C, Dikair A, Allen S, Seymour F, Osborne W, Mathew A, Townsend W, Patten PE, Thoulouli E, Abdulgawad A, Lugthart S, Sanderson R, Kirkwood AA, Kuhnl A. Outcomes after chimeric antigen receptor T-cell therapy across large B-cell lymphoma subtypes. Haematologica 2024. [PMID: 38572567 DOI: 10.3324/haematol.2024.285010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK; UCL Cancer Institute, University College London, London
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London
| | - Adam Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | | | - Ceri Jones
- Department of Haematology. University Hospital of Wales, Cardiff
| | - Abdalla Dikair
- Department of Haematology, Queen Elizabeth Hospital, Glasgow
| | - Sharon Allen
- Department of Haematology, Cambridge University Hospitals, Cambridge
| | | | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle University, Newcastle
| | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham
| | - William Townsend
- Department of Haematology, University College London Hospitals, London
| | - Piers Em Patten
- Department of Haematology, King's College Hospital, London, UK; Comprehensive Cancer Centre, King's College London, London
| | - Eleni Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester
| | | | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol
| | | | - Amy A Kirkwood
- CR UK and UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London.
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4
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Cheok KPL, Farrow A, Springell D, O'Reilly M, Morley S, Stone N, Roddie C. Mucormycosis after CD19 chimeric antigen receptor T-cell therapy: results of a US Food and Drug Administration adverse events reporting system analysis and a review of the literature. Lancet Infect Dis 2024; 24:e256-e265. [PMID: 38310904 DOI: 10.1016/s1473-3099(23)00563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 02/06/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy leads to durable remissions in relapsed B-cell cancers, but treatment-associated immunocompromise leads to a substantial morbidity and mortality risk from atypical infection. Mucormycosis is an aggressive and invasive fungal infection with a mortality risk of 40-80% in patients with haematological malignancies. In this Grand Round, we report a case of mucormycosis in a 54-year-old patient undergoing CAR T-cell therapy who reached complete clinical control of Mucorales with combined aggressive surgical debridement, antifungal pharmacotherapy, and reversal of underlying risk factors, but with substantial morbidity from extensive oro-facial surgery affecting the patient's speech and swallowing. For broader context, we present our case alongside an US Food and Drugs Administration adverse events reporting database analysis and a review of the literature to fully evaluate the clinical burden of mucormycosis in patients treated with CAR T-cell therapy. We discuss epidemiology, clinical features, diagnostic tools, and current frameworks for treatment and prophylaxis. We did this analysis to promote increased vigilance for mucormycosis among physicians specialising in CAR T-cell therapy and microbiologists and to illustrate the importance of early initiation of therapy to effectively manage this condition. Mucormycosis prevention and early diagnosis, through targeted surveillance and mould prevention in patients at highest risk and Mucorales-specific screening assays, is likely to be key to improving outcomes in patients treated with CAR T-cell therapy.
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Affiliation(s)
- Kathleen P L Cheok
- University College London Hospital NHS Foundation Trust, London, UK; University College London Cancer Institute, London, UK.
| | - Adrian Farrow
- University College London Hospital NHS Foundation Trust, London, UK
| | | | - Maeve O'Reilly
- University College London Hospital NHS Foundation Trust, London, UK
| | - Simon Morley
- University College London Hospital NHS Foundation Trust, London, UK
| | - Neil Stone
- University College London Hospital NHS Foundation Trust, London, UK
| | - Claire Roddie
- University College London Hospital NHS Foundation Trust, London, UK; University College London Cancer Institute, London, UK
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5
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Panopoulou A, O'Reilly M, Roddie C. Axi-cel as a safe and effective treatment in older patients with large B-cell lymphoma. Ann Palliat Med 2024; 13:458-461. [PMID: 38509649 DOI: 10.21037/apm-23-562] [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] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/27/2023] [Indexed: 03/22/2024]
Affiliation(s)
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals (UCLH), London, UK; Department of Haematology, University College London (UCL) Cancer Institute, London, UK
| | - Claire Roddie
- Department of Haematology, University College London Hospitals (UCLH), London, UK; Department of Haematology, University College London (UCL) Cancer Institute, London, UK
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6
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Boyle S, Roddie C, O'Reilly M, Menne T, Norman J, Gibb A, Lugthart S, Chaganti S, Gonzalez Arias C, Jones C, Latif A, Uttenthal BJ, Seymour F, Osborne W, Springell D, Hardefeldt P, Yallop D, Thoulouli E, Bloor A, Besley C, Mathew A, Burns D, Cwynarski K, Sanderson R, Kuhnl A. Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time. Br J Haematol 2024; 204:507-513. [PMID: 37848384 DOI: 10.1111/bjh.19157] [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: 07/08/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.
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Affiliation(s)
- S Boyle
- Department of Haematology, King's College Hospital, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
| | - M O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - S Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | - B J Uttenthal
- Department of Haematology, Cambridge University Hospitals, Cambridge, UK
| | - F Seymour
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - D Springell
- Department of Haematology, University College London Hospitals, London, UK
| | - P Hardefeldt
- Department of Haematology, King's College Hospital, London, UK
| | - D Yallop
- Department of Haematology, King's College Hospital, London, UK
| | - E Thoulouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - A Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - D Burns
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - K Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
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7
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Iacoboni G, Navarro V, Martín-López AÁ, Rejeski K, Kwon M, Jalowiec KA, Amat P, Reguera-Ortega JL, Gallur L, Blumenberg V, Gutiérrez-Herrero S, Roddie C, Benzaquén A, Delgado-Serrano J, Sánchez-Salinas MA, Bailén R, Carpio C, López-Corral L, Hernani R, Bastos M, O'Reilly M, Martín-Martín L, Subklewe M, Barba P. Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients With Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy. J Clin Oncol 2024; 42:205-217. [PMID: 37874957 DOI: 10.1200/jco.23.01097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/23/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE Approximately 30%-40% of patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) infused with CD19-targeted chimeric antigen receptor (CAR) T cells achieve durable responses. Consensus guidelines suggest avoiding bendamustine before apheresis, but specific data in this setting are lacking. We report distinct outcomes after CAR T-cell therapy according to previous bendamustine exposure. METHODS The study included CAR T-cell recipients from seven European sites. Safety, efficacy, and CAR T-cell expansion kinetics were analyzed according to preapheresis bendamustine exposure. Additional studies on the impact of the washout period and bendamustine dose were performed. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) analyses were carried out for all efficacy comparisons between bendamustine-exposed and bendamustine-naïve patients. RESULTS The study included 439 patients with R/R LBCL infused with CD19-targeted commercial CAR T cells, of whom 80 had received bendamustine before apheresis. Exposed patients had significantly lower CD3+ cells and platelets at apheresis. These patients had a lower overall response rate (ORR, 53% v 72%; P < .01), a shorter progression-free survival (PFS, 3.1 v 6.2 months; P = .04), and overall survival (OS, 10.3 v 23.5 months; P = .01) in comparison with the bendamustine-naïve group. Following adjustment methods for baseline variables, these differences were mitigated. Focusing on the impact of bendamustine washout before apheresis, those with recent (<9 months) exposure (N = 42) displayed a lower ORR (40% v 72%; P < .01), shorter PFS (1.3 v 6.2 months; P < .01), and OS (4.6 v 23.5 months; P < .01) in comparison with bendamustine-naïve patients. These differences remained significant after IPTW and PSM analysis. Conversely, the cumulative dose of bendamustine before apheresis did not affect CAR-T efficacy outcomes. CONCLUSION Recent bendamustine exposure before apheresis was associated with negative treatment outcomes after CD19-targeted CAR T-cell therapy and should be therefore avoided in CAR T-cell candidates.
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Affiliation(s)
- Gloria Iacoboni
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Víctor Navarro
- Oncology Data Science (ODySey) Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana África Martín-López
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Kai Rejeski
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Katarzyna Aleksandra Jalowiec
- Hematology Department, University College London Cancer Institute, London, United Kingdom
- Department of Hematology and Central Hematology Laboratory, University Hospital of Bern, Bern, Switzerland
| | - Paula Amat
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Juan Luis Reguera-Ortega
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Laura Gallur
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Viktoria Blumenberg
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Sara Gutiérrez-Herrero
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Claire Roddie
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Ana Benzaquén
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Javier Delgado-Serrano
- Hematology Department, Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Mario Andrés Sánchez-Salinas
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Cecilia Carpio
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Lucia López-Corral
- Hematology Department, Hospital Clínico Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
- Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario, Valencia, Spain
- INCLIVA Research Institute, Valencia, Spain
| | - Mariana Bastos
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Maeve O'Reilly
- Hematology Department, University College London Cancer Institute, London, United Kingdom
| | - Lourdes Martín-Martín
- Cancer Research Centre (IBMCC, USAL-CSIC), Institute for Biomedical Research of Salamanca (IBSAL) and Department of Medicine and Cytometry Service (NUCLEUS Research Support Platform), University of Salamanca (USAL), Salamanca, Spain
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK) and Bavarian Center for Cancer Research (BZKF), partner site Munich, Munich, Germany
| | - Pere Barba
- Department of Hematology, University Hospital Vall d'Hebron, Barcelona, Spain
- Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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8
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Hoelzer D, Bassan R, Boissel N, Roddie C, Ribera JM, Jerkeman M. ESMO Clinical Practice Guideline interim update on the use of targeted therapy in acute lymphoblastic leukaemia. Ann Oncol 2024; 35:15-28. [PMID: 37832649 DOI: 10.1016/j.annonc.2023.09.3112] [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: 03/27/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- D Hoelzer
- ONKOLOGIKUM Frankfurt am Museumsufer, Frankfurt, Germany
| | - R Bassan
- Hematology Unit, Ospedale dell'Angelo e Ospedale SS, Giovanni e Paolo, Mestre-Venezia, Italy
| | - N Boissel
- Hematology Department, Saint-Louis Hospital, APHP, Institut de Recherche Saint-Louis, Université de Paris Cité, Paris, France
| | - C Roddie
- Research Department of Haematology, UCL Cancer Institute, London, UK
| | - J M Ribera
- Clinical Hematology Department, ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Jerkeman
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
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9
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O'Reilly MA, Neill L, Collin SM, Stone N, Springell D, Mensah J, Cheok KPL, Jalowiec K, Benjamin R, Kuhnl A, Roddie C, Sanderson R. High pretreatment disease burden as a risk factor for infectious complications following CD19 chimeric antigen receptor T-cell therapy for large B-cell lymphoma. Hemasphere 2024; 8:e29. [PMID: 38434533 PMCID: PMC10878197 DOI: 10.1002/hem3.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 03/05/2024] Open
Abstract
Infection has emerged as the chief cause of non-relapse mortality (NRM) post CD19-targeting chimeric antigen receptor T-cell therapy (CAR-T) therapy. Even though up to 50% of patients may remain infection-free, many suffer multiple severe, life-threatening, or fatal infectious events. The primary aim of this study was to explore severe and life-threatening infections post licensed CAR-T therapy in large B-cell lymphoma, with a focus on the role of disease burden and disease sites in assessing individual risk. We sought to understand the cohort of patients who experience ≥2 infections and those at the highest risk of infectious NRM. Our analysis identifies a higher disease burden after bridging therapy as associated with infection events. Those developing ≥2 infections emerged as a uniquely high-risk cohort, particularly if the second (or beyond) infection occurred during an episode of immune effector cell-associated neurotoxicity syndrome (ICANS) or while on steroids and/or anakinra for ICANS. Herein, we also describe the first reported cases of "CAR-T cold sepsis," a phenomenon characterized by the lack of an appreciable systemic inflammatory response at the time of detection of infection. We propose a risk-based strategy to encourage heightened clinician awareness of cold sepsis, with a view to reducing NRM.
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Affiliation(s)
- Maeve A. O'Reilly
- Department of HaematologyUniversity College London HospitalLondonUK
- University College London Cancer InstituteLondonUK
| | - Lorna Neill
- Department of HaematologyUniversity College London HospitalLondonUK
| | | | - Neil Stone
- Department of Infectious DiseasesUniversity College London HospitalLondonUK
| | | | - Jeremy Mensah
- Department of HaematologyKing's College London HospitalLondonUK
| | | | | | - Reuben Benjamin
- Department of HaematologyKing's College London HospitalLondonUK
| | - Andrea Kuhnl
- Department of HaematologyKing's College London HospitalLondonUK
| | - Claire Roddie
- Department of HaematologyUniversity College London HospitalLondonUK
- University College London Cancer InstituteLondonUK
| | - Robin Sanderson
- Department of HaematologyKing's College London HospitalLondonUK
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10
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Woodruff R, Parekh F, Lamb K, Mekkaoui L, Allen C, Smetanova K, Huang J, Williams A, Toledo GS, Lilova K, Roddie C, Sillibourne J, Pule M. Large-scale manufacturing of base-edited chimeric antigen receptor T cells. Mol Ther Methods Clin Dev 2023; 31:101123. [PMID: 37886606 PMCID: PMC10597784 DOI: 10.1016/j.omtm.2023.101123] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
Base editing is a revolutionary gene-editing technique enabling the introduction of point mutations into the genome without generating detrimental DNA double-stranded breaks. Base-editing enzymes are commonly delivered in the form of modified linear messenger RNA (mRNA) that is costly to produce. Here, we address this problem by developing a simple protocol for manufacturing base-edited cells using circular RNA (circRNA), which is less expensive to synthesize. Compared with linear mRNA, higher editing efficiencies were achieved with circRNA, enabling an 8-fold reduction in the amount of RNA required. We used this protocol to manufacture a clinical dose (1 × 108 cells) of base-edited chimeric antigen receptor (CAR) T cells lacking expression of the inhibitory receptor, PD-1. Editing efficiencies of up to 86% were obtained using 0.25 μg circRNA/1 × 106 cells. Increased editing efficiencies with circRNA were attributed to more efficient translation. These results suggest that circRNA, which is less expensive to produce than linear mRNA, is a viable option for reducing the cost of manufacturing base-edited cells at scale.
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Affiliation(s)
- Rosie Woodruff
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Farhaan Parekh
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Katarina Lamb
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Leila Mekkaoui
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Christopher Allen
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | | | - Jasmine Huang
- Imperial College London, South Kensington Campus, SW7 2AZ London, UK
| | - Alex Williams
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | | | - Koki Lilova
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Claire Roddie
- Deparment of Haematology, Cancer Institute, 72 Huntley Street, WC1E 6BT London, UK
| | - James Sillibourne
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
| | - Martin Pule
- Autolus Therapeutics, The Mediaworks, 191 Wood Lane, W12 7FP London, UK
- Deparment of Haematology, Cancer Institute, 72 Huntley Street, WC1E 6BT London, UK
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11
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Cheok KPL, Kirkwood AA, Creasey T, Tholouli E, Chaganti S, Mathew A, Dulobdas V, Irvine D, Besley C, Neil L, Lown R, Menne T, Townsend W, Kuhnl A, O'Reilly M, Sanderson R, Sanchez E, Roddie C. Improved COVID-19 outcomes in CAR-T patients in the age of vaccination and preemptive pharmacotherapeutics. Leuk Lymphoma 2023; 64:2037-2041. [PMID: 37602678 DOI: 10.1080/10428194.2023.2248329] [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: 06/14/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Kathleen P L Cheok
- Research Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Thomas Creasey
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - David Irvine
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston NHS Foundation Trusts, Bristol, UK
| | - Lorna Neil
- Department of Haematology, University Hospitals Bristol and Weston NHS Foundation Trusts, Bristol, UK
| | - Robert Lown
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - William Townsend
- Department of Hematology, University College London Hospital, London, UK
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Maeve O'Reilly
- Department of Hematology, University College London Hospital, London, UK
| | - Robin Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - Emilie Sanchez
- Department of Virology, University College London Hospital, UK
| | - Claire Roddie
- Research Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
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12
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Mehra V, Chhetri JB, Ali S, Roddie C. The Emerging Role of Induced Pluripotent Stem Cells as Adoptive Cellular Immunotherapeutics. Biology (Basel) 2023; 12:1419. [PMID: 37998018 PMCID: PMC10669440 DOI: 10.3390/biology12111419] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
Adoptive cell therapy (ACT) has transformed the treatment landscape for cancer and infectious disease through the investigational use of chimeric antigen receptor T-cells (CAR-Ts), tumour-infiltrating lymphocytes (TILs) and viral-specific T-cells (VSTs). Whilst these represent breakthrough treatments, there are subsets of patients who fail to respond to autologous ACT products. This is frequently due to impaired patient T-cell function or "fitness" as a consequence of prior treatments and age, and can be exacerbated by complex manufacturing protocols. Further, the manufacture of autologous, patient-specific products is time-consuming, expensive and non-standardised. Induced pluripotent stem cells (iPSCs) as an allogeneic alternative to patient-specific products can potentially overcome the issues outlined above. iPSC technology provides an unlimited source of rejuvenated iPSC-derived T-cells (T-iPSCs) or natural killer (NK) cells (NK-iPSCs), and in the context of the growing field of allogeneic ACT, iPSCs have enormous potential as a platform for generating off-the-shelf, standardised, "fit" therapeutics for patients. In this review, we evaluate current and future applications of iPSC technology in the CAR-T/NK, TIL and VST space. We discuss current and next-generation iPSC manufacturing protocols, and report on current iPSC-based adoptive therapy clinical trials to elucidate the potential of this technology as the future of ACT.
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Affiliation(s)
| | | | | | - Claire Roddie
- Research Department of Haematology, Cancer Institute, University College London, Paul O’Gorman Building, London WCIE 6DD, UK
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13
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Rampotas A, Sockel K, Panitsas F, Theuser C, Bornhauser M, Hernani R, Hernandez-Boluda JC, Esquirol A, Avenoso D, Tsirigotis P, Robin M, Czerw T, Helbig G, Roddie C, Lambert J, McLornan DP. Adoptive Immunotherapy via Donor Lymphocyte Infusions following Allogeneic Hematopoietic Stem Cell Transplantation for Myelofibrosis: A Real-World, Retrospective Multicenter Study. Transplant Cell Ther 2023; 29:687.e1-687.e7. [PMID: 37633414 DOI: 10.1016/j.jtct.2023.08.020] [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: 04/06/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) remains the sole curative option for myelofibrosis (MF). Relapse remains a significant problem, however, occurring in up to 20% to 30% of cases. Donor lymphocyte infusion (DLI) represents a potentially effective strategy for relapse prevention and management, but the optimal timing based on measurable residual disease/chimerism analyses and the choice of regimen remain undetermined. We performed a retrospective real-world analysis of a multicenter cohort of MF allo-HCT recipients from 8 European transplantation centers who received DLI between 2005 and 2022. Response was assessed using International Working Group-Myeloproliferative Neoplasms Research and Treatment-defined response criteria, and survival endpoints were estimated using the Kaplan-Meier estimator and log-rank test. The study included 28 patients with a median age of 58 years and a Karnofsky Performance Status of >80. The majority of patients had Dynamic International Prognostic Scoring System-plus intermediate-2 or high-risk disease at the time of allo-HCT. In vivo T cell depletion was used in 20 patients (71.2%), with 19 of the 20 receiving antithymocyte globulin. The indication for DLI was either "preemptive" (n = 15), due to a decrease in recipient chimerism (n = 13) or molecular relapse (n = 2), or "therapeutic" (n = 13) for clinician-defined hematologic/clinical relapse. No patient received DLI prophylactically. The median time of DLI administration was 23.4 months post allo-HCT. Of the 16 patients receiving multiple DLIs, 12 were part of a planned escalating dose regimen. The median follow-up from the time of first DLI was 55.4 months. The responses to DLI were complete response in 9 patients, partial response in 1 patient, and clinical improvement in 6 patients. Chimerism levels improved in 16 patients, and stable disease was reported in 5 patients. No response or progression was reported in 7 patients. DLI-induced acute graft-versus-host disease (aGVHD) was reported in 11 patients (39%), with grade III-IV aGVHD in 7 (25%). The median overall survival from the time of first DLI was 62.6 months, and the cumulative incidence of relapse/progression after first DLI was 30.8% at 6 months. This study highlights that good response rates can be achieved with DLI even after frank relapse in some patients in a cohort in which other treatment options are very limited. More prospective studies are warranted to identify the optimal DLI regimen and timing to improve patient outcomes.
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Affiliation(s)
- Alexandros Rampotas
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom.
| | - Katja Sockel
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Fotios Panitsas
- Department of Haematology, Laikon University Hospital, Athens, Greece
| | - Catrin Theuser
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Martin Bornhauser
- Medical Clinic and Policlinic I, University Hospital Dresden, TU Dresden, Germany
| | - Rafael Hernani
- Haematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Albert Esquirol
- Department of Haematology, Hospital de la Santa creu i Sant Pau and Universitat Autonoma de Barcelona, Spain
| | - Daniele Avenoso
- Department of Haematology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marie Robin
- Service d'Hématologie-Greffe, Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France
| | - Tomasz Czerw
- Department of Haematology and Bone Marrow Transplantation, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Claire Roddie
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan Lambert
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Donal P McLornan
- Department of Haematology and Cell Therapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
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14
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Rejeski K, Subklewe M, Aljurf M, Bachy E, Balduzzi A, Barba P, Bruno B, Benjamin R, Carrabba MG, Chabannon C, Ciceri F, Corradini P, Delgado J, Di Blasi R, Greco R, Houot R, Iacoboni G, Jäger U, Kersten MJ, Mielke S, Nagler A, Onida F, Peric Z, Roddie C, Ruggeri A, Sánchez-Guijo F, Sánchez-Ortega I, Schneidawind D, Schubert ML, Snowden JA, Thieblemont C, Topp M, Zinzani PL, Gribben JG, Bonini C, Sureda A, Yakoub-Agha I. Immune effector cell-associated hematotoxicity: EHA/EBMT consensus grading and best practice recommendations. Blood 2023; 142:865-877. [PMID: 37300386 DOI: 10.1182/blood.2023020578] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [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: 03/27/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Hematological toxicity is the most common adverse event after chimeric antigen receptor (CAR) T-cell therapy. Cytopenias can be profound and long-lasting and can predispose for severe infectious complications. In a recent worldwide survey, we demonstrated that there remains considerable heterogeneity in regard to current practice patterns. Here, we sought to build consensus on the grading and management of immune effector cell-associated hematotoxicity (ICAHT) after CAR T-cell therapy. For this purpose, a joint effort between the European Society for Blood and Marrow Transplantation (EBMT) and the European Hematology Association (EHA) involved an international panel of 36 CAR T-cell experts who met in a series of virtual conferences, culminating in a 2-day meeting in Lille, France. On the basis of these deliberations, best practice recommendations were developed. For the grading of ICAHT, a classification system based on depth and duration of neutropenia was developed for early (day 0-30) and late (after day +30) cytopenia. Detailed recommendations on risk factors, available preinfusion scoring systems (eg, CAR-HEMATOTOX score), and diagnostic workup are provided. A further section focuses on identifying hemophagocytosis in the context of severe hematotoxicity. Finally, we review current evidence and provide consensus recommendations for the management of ICAHT, including growth factor support, anti-infectious prophylaxis, transfusions, autologous hematopoietic stem cell boost, and allogeneic hematopoietic cell transplantation. In conclusion, we propose ICAHT as a novel toxicity category after immune effector cell therapy, provide a framework for its grading, review literature on risk factors, and outline expert recommendations for the diagnostic workup and short- and long-term management.
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Affiliation(s)
- Kai Rejeski
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Adriana Balduzzi
- Pediatric Transplantation Unit, Department of Medicine and Surgery, University of Milan-Bicocca-Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Pere Barba
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Benedetto Bruno
- Division of Hematology and Cell Therapy Unit, Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Reuben Benjamin
- School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Matteo G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Christian Chabannon
- Institut Paoli-Calmettes Comprehensive Cancer Centre and Module Biothérapies du Centre d'Investigations Cliniques de Marseille, INSERM-Aix-Marseille Université-AP-HM-IPC, CBT-1409, Marseille, France
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Corradini
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Instituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Julio Delgado
- Oncoimmunotherapy Unit, Department of Hematology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Roberta Di Blasi
- Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France
| | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roch Houot
- Department of Hematology, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ulrich Jäger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Department of Laboratory Medicine and Medicine Huddinge, Karolinska University Hospital and Institute, Stockholm, Sweden
| | - Arnon Nagler
- Division of Hematology, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Francesco Onida
- Hematology and Bone Marrow Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Zinaida Peric
- Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Claire Roddie
- Department of Hematology, University College London Hospital, London, United Kingdom
| | - Annalisa Ruggeri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fermín Sánchez-Guijo
- University of Salamanca, IBSAL-University Hospital of Salamanca, Salamanca, Spain
| | - Isabel Sánchez-Ortega
- Executive Office, European Society for Blood and Marrow Transplantation, Barcelona, Spain
| | - Dominik Schneidawind
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Catherine Thieblemont
- Université de Paris, Assistance Publique-Hopitaux de Paris, Service d'hémato-oncologie, Paris, France
| | - Max Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - John G Gribben
- Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Chiara Bonini
- Division of Immunology, Transplantation and Infectious Disease, Experimental Hematology Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-L'Hospitalet, Barcelona, Spain
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15
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Mehra V, Agliardi G, Dias Alves Pinto J, Shafat MS, Garai AC, Green L, Hotblack A, Arce Vargas F, Peggs KS, van der Waart AB, Dolstra H, Pule MA, Roddie C. AKT inhibition generates potent polyfunctional clinical grade AUTO1 CAR T-cells, enhancing function and survival. J Immunother Cancer 2023; 11:e007002. [PMID: 37709295 PMCID: PMC10503365 DOI: 10.1136/jitc-2023-007002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AUTO1 is a fast off-rate CD19-targeting chimeric antigen receptor (CAR), which has been successfully tested in adult lymphoblastic leukemia. Tscm/Tcm-enriched CAR-T populations confer the best expansion and persistence, but Tscm/Tcm numbers are poor in heavily pretreated adult patients. To improve this, we evaluate the use of AKT inhibitor (VIII) with the aim of uncoupling T-cell expansion from differentiation, to enrich Tscm/Tcm subsets. METHODS VIII was incorporated into the AUTO1 manufacturing process based on the semiautomated the CliniMACS Prodigy platform at both small and cGMP scale. RESULTS AUTO1 manufactured with VIII showed Tscm/Tcm enrichment, improved expansion and cytotoxicity in vitro and superior antitumor activity in vivo. Further, VIII induced AUTO1 Th1/Th17 skewing, increased polyfunctionality, and conferred a unique metabolic profile and a novel signature for autophagy to support enhanced expansion and cytotoxicity. We show that VIII-cultured AUTO1 products from B-ALL patients on the ALLCAR19 study possess superior phenotype, metabolism, and function than parallel control products and that VIII-based manufacture is scalable to cGMP. CONCLUSION Ultimately, AUTO1 generated with VIII may begin to overcome the product specific factors contributing to CD19+relapse.
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Affiliation(s)
- Vedika Mehra
- Research Department of Haematology, University College London, London, UK
| | - Giulia Agliardi
- Research Department of Haematology, University College London, London, UK
- Centre for Cell, Gene and Tissue Therapeutics, Royal Free Hospital, London, UK
| | - Juliana Dias Alves Pinto
- Research Department of Haematology, University College London, London, UK
- Centre for Cell, Gene and Tissue Therapeutics, Royal Free Hospital, London, UK
| | - Manar S Shafat
- Research Department of Haematology, University College London, London, UK
| | | | - Louisa Green
- Research Department of Haematology, University College London, London, UK
| | - Alastair Hotblack
- Research Department of Haematology, University College London, London, UK
| | | | - Karl S Peggs
- Research Department of Haematology, University College London, London, UK
| | - Anniek B van der Waart
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Harry Dolstra
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Martin A Pule
- Research Department of Haematology, University College London, London, UK
- Autolus Ltd, London, UK
| | - Claire Roddie
- Research Department of Haematology, University College London, London, UK
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16
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Springell D, O'Reilly M, Roddie C. Supportive care for chimeric antigen receptor T-cell patients. Curr Opin Support Palliat Care 2023; 17:231-239. [PMID: 37418578 DOI: 10.1097/spc.0000000000000657] [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] [Indexed: 07/09/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide clear guidance to health professionals delivering chimeric antigen receptor T-cell (CAR-T) therapy on the best supportive management throughout the CAR-T pathway, from referral to long-term follow-up, including psychosocial aspects. RECENT FINDINGS CAR-T therapy has changed the treatment landscape for relapsed/refractory (r/r) B-cell malignancy. Approximately 40% of r/r B-cell leukaemia/lymphoma patients receiving CD19-targeted CAR-T therapy achieve durable remission following a single dose. The field is rapidly expanding to encompass new CAR-T products for indications such as multiple myeloma, mantle cell lymphoma and follicular lymphoma, and the number of patients eligible to receive CAR-T therapy is likely to continue to grow exponentially. CAR-T therapy is logistically challenging to deliver, with involvement of many stakeholders. In many cases, CAR-T therapy requires an extended inpatient hospital admission, particularly in older, comorbid patients, and is associated with potentially severe immune side effects. Further, CAR-T therapy can lead to protracted cytopenias that can last for several months accompanied by a susceptibility to infection. SUMMARY For the reasons listed above, standardised, comprehensive supportive care is critically important to ensure that CAR-T therapy is delivered as safely as possible and that patients are fully informed of the risks and benefits, as well as the requirement for extended hospital admission and follow-up, to fully realise the potential of this transformative treatment modality.
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Affiliation(s)
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospital
| | - Claire Roddie
- Department of Haematology, University College London Hospital
- Research Department of Haematology, University College London, London, UK
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17
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Roddie C, Neill L, Osborne W, Iyengar S, Tholouli E, Irvine D, Chaganti S, Besley C, Bloor A, Jones C, Uttenthal B, Johnson R, Sanderson R, Cheok K, Marzolini M, Townsend W, O'Reilly M, Kirkwood AA, Kuhnl A. Effective bridging therapy can improve CD19 CAR-T outcomes while maintaining safety in patients with large B-cell lymphoma. Blood Adv 2023; 7:2872-2883. [PMID: 36724512 PMCID: PMC10300297 DOI: 10.1182/bloodadvances.2022009019] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [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: 09/26/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
The impact of bridging therapy (BT) on CD19-directed chimeric antigen receptor T-cell (CD19CAR-T) outcomes in large B-cell lymphoma (LBCL) is poorly characterized. Current practice is guided through physician preference rather than established evidence. Identification of effective BT modalities and factors predictive of response could improve both CAR-T intention to treat and clinical outcomes. We assessed BT modality and response in 375 adult patients with LBCL in relation to outcomes after axicabtagene ciloleucel (Axi-cel) or tisagenlecleucel (Tisa-cel) administration. The majority of patients received BT with chemotherapy (57%) or radiotherapy (17%). We observed that BT was safe for patients, with minimal morbidity or mortality. We showed that complete or partial response to BT conferred a 42% reduction in disease progression and death after CD19CAR-T therapy. Multivariate analysis identified several factors associated with likelihood of response to BT, including response to last line therapy, the absence of bulky disease, and the use of polatuzumab-containing chemotherapy regimens. Our data suggested that complete or partial response to BT may be more important for Tisa-cel than for Axi-cel, because all patients receiving Tisa-cel with less than partial response to BT experienced frank relapse within 12 months of CD19CAR-T infusion. In summary, BT in LBCL should be carefully planned toward optimal response and disease debulking, to improve patient outcomes associated with CD19CAR-T. Polatuzumab-containing regimens should be strongly considered for all suitable patients, and failure to achieve complete or partial response to BT before Tisa-cel administration may prompt consideration of further lines of BT where possible.
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Affiliation(s)
- Claire Roddie
- Department of Haematology, University College London Hospitals, London, United Kingdom
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
| | - Lorna Neill
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - Sunil Iyengar
- Department of Haematology, Royal Marsden Hospital, London, United Kingdom
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - David Irvine
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, United Kingdom
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Caroline Besley
- Department of Haematology, University Hospital Bristol, Bristol, United Kingdom
| | - Adrian Bloor
- Department of Haematology, The Christie Hospital, Manchester, United Kingdom
| | - Ceri Jones
- Department of Haematology, Cardiff University Hospital, Cardiff, United Kingdom
| | - Ben Uttenthal
- Department of Haematology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Rod Johnson
- Department of Haematology, St. James’s Hospital, Leeds, United Kingdom
| | - Robin Sanderson
- Department of Haematology, King’s College Hospital, London, United Kingdom
| | - Kathleen Cheok
- Department of Haematology, University College London Hospitals, London, United Kingdom
- Research Department of Haematology, University College London Cancer Institute, University College London, London, United Kingdom
| | - Maria Marzolini
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - William Townsend
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Amy A. Kirkwood
- Cancer Research United Kingdom & University College London Cancer Trials Centre, University College London Cancer Institute, University College London, London, United Kingdom
| | - Andrea Kuhnl
- Department of Haematology, King’s College Hospital, London, United Kingdom
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18
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Roddie C, Lekakis LJ, Marzolini MAV, Ramakrishnan A, Zhang Y, Hu Y, Peddareddigari VGR, Khokhar N, Chen R, Basilico S, Raymond M, Vargas FA, Duffy K, Brugger W, O’Reilly MA, Wood L, Linch DC, Peggs KS, Bachier C, Budde EL, Lee Batlevi C, Bartlett N, Irvine D, Tholouli E, Osborne W, Ardeshna KM, Pule MA. Dual targeting of CD19 and CD22 with bicistronic CAR-T cells in patients with relapsed/refractory large B-cell lymphoma. Blood 2023; 141:2470-2482. [PMID: 36821767 PMCID: PMC10646794 DOI: 10.1182/blood.2022018598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Relapse after CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL) is commonly ascribed to antigen loss or CAR-T exhaustion. Multiantigen targeting and programmed cell death protein-1 blockade are rational approaches to prevent relapse. Here, we test CD19/22 dual-targeting CAR-T (AUTO3) plus pembrolizumab in relapsed/refractory LBCL (NCT03289455). End points include toxicity (primary) and response rates (secondary). Fifty-two patients received AUTO3 and 48/52 received pembrolizumab. Median age was 59 years (range, 27-83), 46/52 had stage III/ IV disease and median follow-up was 21.6 months. AUTO3 was safe; grade 1-2 and grade 3 cytokine release syndrome affected 18/52 (34.6%) and 1/52 (1.9%) patients, neurotoxicity arose in 4 patients (2/4, grade 3-4), and hemophagocytic lymphohistiocytosis affected 2 patients. Outpatient administration was tested in 20 patients, saving a median of 14 hospital days per patient. Overall response rates were 66% (48.9%, complete response [CR]; 17%, partial response). Median duration of remission (DOR) for CR patients was not reached and for all responding patients was 8.3 months (95% confidence interval [CI]: 3.0-not evaluable). 54.4% (CI: 32.8-71.7) of CR patients and 42.6% of all responding patients were projected to remain progression-free at ≥12 months. AUTO3 ± pembrolizumab for relapsed/refractory LBCL was safe and delivered durable remissions in 54.4% of complete responders, associated with robust CAR-T expansion. Neither dual-targeting CAR-T nor pembrolizumab prevented relapse in a significant proportion of patients, and future developments include next-generation-AUTO3, engineered for superior expansion in vivo, and selection of CAR binders active at low antigen densities.
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Affiliation(s)
- Claire Roddie
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Lazaros J. Lekakis
- Department of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Maria A. V. Marzolini
- Department of Haematology, University College London Hospital, London, United Kingdom
| | | | - Yiyun Zhang
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Yanqing Hu
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | | | - Nushmia Khokhar
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Robert Chen
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Silvia Basilico
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Meera Raymond
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | | | - Kevin Duffy
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Wolfram Brugger
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Maeve A. O’Reilly
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Leigh Wood
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - David C. Linch
- Cancer Institute, University College London, London, United Kingdom
| | - Karl S. Peggs
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Carlos Bachier
- Department of Hematology, Methodist Hospital, San Antonio, TX
| | | | - Connie Lee Batlevi
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Bartlett
- Department of Hematology, Washington University School of Medicine, St Louis, MO
| | - David Irvine
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - Kirit M. Ardeshna
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Martin A. Pule
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, Autolus Ltd, London, United Kingdom
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19
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Kuhnl A, Kirkwood AA, Roddie C, Menne T, Tholouli E, Bloor A, Besley C, Chaganti S, Osborne W, Norman J, Gibb A, Sharplin K, Cuadrado M, Correia de Farias M, Cheok K, Neill L, Latif AL, González Arias C, Uttenthal B, Jones C, Johnson R, McMillan A, Sanderson R, Townsend W. CAR T in patients with large B-cell lymphoma not fit for autologous transplant. Br J Haematol 2023. [PMID: 37082780 DOI: 10.1111/bjh.18810] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.
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Affiliation(s)
- A Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - A A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - C Roddie
- Department of Haematology, University College London Hospitals, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - T Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - E Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - C Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - S Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - W Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - J Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - A Gibb
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - K Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - M Cuadrado
- Department of Haematology, King's College Hospital, London, UK
| | | | - K Cheok
- Department of Haematology, University College London Hospitals, London, UK
| | - L Neill
- Department of Haematology, University College London Hospitals, London, UK
| | - A L Latif
- Department of Haematology, Queen Elizabeth II Hospital, Glasgow, UK
| | | | - B Uttenthal
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - C Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - R Johnson
- Department of Haematology, St. James's Hospital, Leeds, UK
| | - A McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
| | - R Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - W Townsend
- Department of Haematology, University College London Hospitals, London, UK
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20
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Mahdi J, Dietrich J, Straathof K, Roddie C, Scott BJ, Davidson TB, Prolo LM, Batchelor TT, Campen CJ, Davis KL, Gust J, Lim M, Majzner RG, Park JR, Partap S, Ramakrishna S, Richards R, Schultz L, Vitanza NA, Wang LD, Mackall CL, Monje M. Tumor inflammation-associated neurotoxicity. Nat Med 2023; 29:803-810. [PMID: 37024595 PMCID: PMC10166099 DOI: 10.1038/s41591-023-02276-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
Cancer immunotherapies have unique toxicities. Establishment of grading scales and standardized grade-based treatment algorithms for toxicity syndromes can improve the safety of these treatments, as observed for cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) in patients with B cell malignancies treated with chimeric antigen receptor (CAR) T cell therapy. We have observed a toxicity syndrome, distinct from CRS and ICANS, in patients treated with cell therapies for tumors in the central nervous system (CNS), which we term tumor inflammation-associated neurotoxicity (TIAN). Encompassing the concept of 'pseudoprogression,' but broader than inflammation-induced edema alone, TIAN is relevant not only to cellular therapies, but also to other immunotherapies for CNS tumors. To facilitate the safe administration of cell therapies for patients with CNS tumors, we define TIAN, propose a toxicity grading scale for TIAN syndrome and discuss the potential management of this entity, with the goal of standardizing both reporting and management.
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Affiliation(s)
- Jasia Mahdi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Karin Straathof
- Research Department of Hematology and Oncology, Cancer Institute, University College London, London, UK
| | - Claire Roddie
- Research Department of Hematology and Oncology, Cancer Institute, University College London, London, UK
| | - Brian J Scott
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Tom Belle Davidson
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura M Prolo
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Cynthia J Campen
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Kara L Davis
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Juliane Gust
- Department of Neurology, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, WA, USA
| | - Michael Lim
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Robbie G Majzner
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Julie R Park
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Sonia Partap
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Sneha Ramakrishna
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Rebecca Richards
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Liora Schultz
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Nicholas A Vitanza
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leo D Wang
- City of Hope, Departments of Pediatrics and Immuno-oncology, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, USA
| | - Crystal L Mackall
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
- Stanford Center for Cancer Cell Therapy, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Department of Pathology, Stanford University, Stanford, CA, USA.
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
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21
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O'Reilly MA, Malhi A, Cheok KPL, Ings S, Balsa C, Keane H, Jalowiec K, Neill L, Peggs KS, Roddie C. A novel predictive algorithm to personalize autologous T-cell harvest for chimeric antigen receptor T-cell manufacture. Cytotherapy 2023; 25:323-329. [PMID: 36513573 DOI: 10.1016/j.jcyt.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/03/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AIMS The most widely accepted starting materials for chimeric antigen receptor T-cell manufacture are autologous CD3+ T cells obtained via the process of leukapheresis, also known as T-cell harvest. As this treatment modality gains momentum and apheresis units struggle to meet demand for harvest slots, strategies to streamline this critical step are warranted. METHODS This retrospective review of 262 T-cell harvests, with a control cohort of healthy donors, analyzed the parameters impacting CD3+ T-cell yield in adults with B-cell malignancies. The overall aim was to design a novel predictive algorithm to guide the required processed blood volume (PBV) (L) on the apheresis machine to achieve a specific CD3+ target yield. RESULTS Factors associated with CD3+ T-cell yield on multivariate analysis included peripheral blood CD3+ count (natural log, ×109/L), hematocrit (HCT) and PBV with coefficients of 0.86 (95% confidence interval [CI], 0.80-0.92, P < 0.001), 1.30 (95% CI, 0.51-2.08, P = 0.001) and 0.09 (95% CI, 0.07-0.11, P < 0.001), respectively. The authors' model, incorporating CD3+ cell count, HCT and PBV (L), with an adjusted R2 of 0.87 and root-mean-square error of 0.26 in the training dataset, was highly predictive of CD3+ cell yield in the testing dataset. An online application to estimate PBV using this algorithm can be accessed at https://cd3yield.shinyapps.io/cd3yield/. CONCLUSIONS The authors propose a transferrable model that incorporates clinical and laboratory variables accessible pre-harvest for use across the field of T-cell therapy. Pending further validation, such a model may be used to generate an individual leukapheresis plan and streamline the process of cell harvest, a well-recognized bottleneck in the industry.
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Affiliation(s)
- Maeve A O'Reilly
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK. maeve.o'
| | - Aman Malhi
- Cancer Research UK & University College London Cancer Trials Center, University College London, London, UK
| | - Kathleen P L Cheok
- Department of Hematology, University College London Hospital, London, UK
| | - Stuart Ings
- Department of Hematology, University College London Hospital, London, UK
| | - Carmen Balsa
- Department of Hematology, University College London Hospital, London, UK
| | - Helen Keane
- Department of Hematology, University College London Hospital, London, UK
| | - Katarzyna Jalowiec
- Department of Hematology, University College London Hospital, London, UK
| | - Lorna Neill
- Department of Hematology, University College London Hospital, London, UK
| | - Karl S Peggs
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK
| | - Claire Roddie
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK
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22
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Abstract
Chimeric antigen receptor (CAR) T-cells are considered "living drugs" and offer a compelling alternative to conventional anticancer therapies. Briefly, T-cells are redirected, using gene engineering technology, toward a specific cancer cell surface target antigen via a synthetic chimeric antigen receptor (CAR) protein. CARs have a modular design comprising four main structures: an antigen-binding domain, a hinge region, a transmembrane domain, and one or more intracellular signaling domains for T-cell activation. A major challenge in the CAR T-cell manufacturing field is balancing product quality with scalability and cost-effectiveness, especially when transitioning from an academic clinical trial into a marketed product, to be implemented across many collection, manufacturing, and treatment sites. Achieving product consistency while circumnavigating the intrinsic variability associated with autologous products is an additional barrier. To overcome these limitations, a robust understanding of the product and its biological actions is crucial to establish a target product profile with a defined list of critical quality attributes to be assessed for each batch prior to product certification. Additional challenges arise as the field progresses, such as new safety considerations associated with the use of allogenic T-cells and genome editing tools. In this chapter, we will discuss the release and potency assays required for CAR T-cell manufacturing, covering their relevance, current challenges, and future perspectives.
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Affiliation(s)
- Juliana Dias
- UCL Cancer Institute, University College London, London, UK.
- Royal Free Hospital London, NHS Foundation Trust, London, UK.
| | - Amaia Cadiñanos-Garai
- USC/CHLA Cell Therapy Program, Keck School of Medicine of USC, University of Southern California (USC), Los Angeles, CA, USA
| | - Claire Roddie
- UCL Cancer Institute, University College London, London, UK
- Department of Haematology, UCL Hospital, London, UK
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23
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Cheok KPL, Kirkwood AA, Menne T, Tholouli E, Chaganti S, Mathew A, Uttenthal B, Russell J, Irvine D, Johnson R, Nicholson E, Bazin J, Townsend W, Kuhnl A, O’Reilly M, Sanderson R, Patel A, Roddie C. Severe presentations and high mortality from SARS-CoV-2 in patients undergoing chimeric antigen receptor (CAR-T) therapy: a UK NCCP analysis. Leuk Lymphoma 2022; 63:1980-1984. [DOI: 10.1080/10428194.2022.2057487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kathleen P. L. Cheok
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
| | - Amy A. Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Tobias Menne
- Department of Hematology, Freeman Hospital, Newcastle, UK
| | - Eleni Tholouli
- Department of Hematology, Manchester Royal Infirmary, Manchester, UK
| | - Sridhar Chaganti
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Amrith Mathew
- Department of Hematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Uttenthal
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - James Russell
- Department of Hematology, Addenbrooke’s Hospital, Cambridge, UK
| | - David Irvine
- Department of Hematology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rod Johnson
- Department of Hematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Nicholson
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - Jessica Bazin
- Department of Hematology, Royal Marsden Hospital, London, UK
| | - William Townsend
- Department of Hematology, University College London Hospital, London, UK
| | - Andrea Kuhnl
- Department of Hematology, King’s College Hospital, London, UK
| | - Maeve O’Reilly
- Department of Hematology, University College London Hospital, London, UK
| | - Robin Sanderson
- Department of Hematology, King’s College Hospital, London, UK
| | - Amit Patel
- Department of Hematology, Christie Hospital, Manchester, UK
| | - Claire Roddie
- Department of Hematology, University College London, London, UK
- Department of Hematology, University College London Hospital, London, UK
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Kuhnl A, Roddie C, Kirkwood AA, Tholouli E, Menne T, Patel A, Besley C, Chaganti S, Sanderson R, O'Reilly M, Norman J, Osborne W, Bloor A, Lugthart S, Malladi R, Patten PEM, Neill L, Martinez-Cibrian N, Kennedy H, Phillips EH, Jones C, Sharplin K, El-Sharkawi D, Latif AL, Mathew A, Uttenthal B, Stewart O, Marzolini MAV, Townsend W, Cwynarski K, Ardeshna K, Ardavan A, Robinson K, Pagliuca A, Collins GP, Johnson R, McMillan A. A national service for delivering CD19 CAR-Tin large B-cell lymphoma - The UK real-world experience. Br J Haematol 2022; 198:492-502. [PMID: 35485402 DOI: 10.1111/bjh.18209] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/22/2022] [Accepted: 04/08/2022] [Indexed: 01/01/2023]
Abstract
CD19 CAR-T have emerged as a new standard treatment for relapsed/refractory (r/r) large B-cell lymphoma (LBCL). CAR-T real-world (RW) outcomes published to date suggest significant variability across countries. We provide results of a large national cohort of patients intended to be treated with CAR-T in the UK. Consecutive patients with r/r LBCL approved for CAR-T by the National CAR-T Clinical Panel between December 2018 and November 2020 across all UK CAR-T centres were included. 404/432 patients were approved [292 axicabtagene ciloleucel (axi-cel), 112 tisagenlecleucel (tisa-cel)], 300 (74%) received the cells. 110/300 (38.3%) patients achieved complete remission (CR) at 6 months (m). The overall response rate was 77% (52% CR) for axi-cel, 57% (44% CR) for tisa-cel. The 12-month progression-free survival was 41.8% (axi-cel) and 27.4% (tisa-cel). Median overall survival for the intention-to-treat population was 10.5 m, 16.2 m for infused patients. The incidence of grade ≥3 cytokine release syndrome and neurotoxicity were 7.6%/19.6% for axi-cel and 7.9%/3.9% for tisa-cel. This prospective RW population of CAR-T eligible patients offers important insights into the clinical benefit of CD19 CAR-T in LBCL in daily practice. Our results confirm long-term efficacy in patients receiving treatment similar to the pivotal trials, but highlight the significance of early CAR-T failure.
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Affiliation(s)
- Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Amit Patel
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Caroline Besley
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Robin Sanderson
- Department of Haematology, King's College Hospital, London, UK
| | - Maeve O'Reilly
- Department of Haematology, University College London Hospitals, London, UK
| | - Jane Norman
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Adrian Bloor
- Department of Haematology, The Christie Hospital, Manchester, UK
| | - Sanne Lugthart
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | - Ram Malladi
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK.,Department of Haematology, Addenbrookes Hospital, Cambridge, UK
| | - Piers E M Patten
- Department of Haematology, King's College Hospital, London, UK.,Comprehensive Cancer Centre, King's College London, London, UK
| | - Lorna Neill
- Department of Haematology, University College London Hospitals, London, UK
| | | | - Hannah Kennedy
- Department of Haematology, Freeman Hospital, Newcastle, UK
| | - Elizabeth H Phillips
- Department of Medical Oncology, The Christie Hospital, Manchester, UK.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ceri Jones
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - Kirsty Sharplin
- Department of Haematology, University Hospitals Bristol and Weston, Bristol, UK
| | | | | | - Amrith Mathew
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Orla Stewart
- Department of Haematology, King's College Hospital, London, UK
| | | | - William Townsend
- Department of Haematology, University College London Hospitals, London, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals, London, UK
| | - Arzhang Ardavan
- NCRI Consumer Forum, London, UK.,Department of Physics, University of Oxford, UK
| | | | | | - Graham P Collins
- Department of Haematology, Oxford University Hospital, Oxford, UK
| | | | - Andrew McMillan
- Department of Haematology, Nottingham University Hospitals, Nottingham, UK
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25
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Culshaw A, Vargas FA, Toledo GS, Roddie C, Shaughnessy P, Duffy K, Brugger W, Merges M, Pule M. Industrialization of an Academic Miltenyi Prodigy-Based CAR T Process. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Hayden PJ, Roddie C, Bader P, Basak GW, Bonig H, Bonini C, Chabannon C, Ciceri F, Corbacioglu S, Ellard R, Sanchez-Guijo F, Jäger U, Hildebrandt M, Hudecek M, Kersten MJ, Köhl U, Kuball J, Mielke S, Mohty M, Murray J, Nagler A, Rees J, Rioufol C, Saccardi R, Snowden JA, Styczynski J, Subklewe M, Thieblemont C, Topp M, Ispizua ÁU, Chen D, Vrhovac R, Gribben JG, Kröger N, Einsele H, Yakoub-Agha I. Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA). Ann Oncol 2022; 33:259-275. [PMID: 34923107 DOI: 10.1016/j.annonc.2021.12.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 62.5] [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: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Several commercial and academic autologous chimeric antigen receptor T-cell (CAR-T) products targeting CD19 have been approved in Europe for relapsed/refractory B-cell acute lymphoblastic leukemia, high-grade B-cell lymphoma and mantle cell lymphoma. Products for other diseases such as multiple myeloma and follicular lymphoma are likely to be approved by the European Medicines Agency in the near future. DESIGN The European Society for Blood and Marrow Transplantation (EBMT)-Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association collaborated to draft best practice recommendations based on the current literature to support health care professionals in delivering consistent, high-quality care in this rapidly moving field. RESULTS Thirty-six CAR-T experts (medical, nursing, pharmacy/laboratory) assembled to draft recommendations to cover all aspects of CAR-T patient care and supply chain management, from patient selection to long-term follow-up, post-authorisation safety surveillance and regulatory issues. CONCLUSIONS We provide practical, clinically relevant recommendations on the use of these high-cost, logistically complex therapies for haematologists/oncologists, nurses and other stakeholders including pharmacists and health sector administrators involved in the delivery of CAR-T in the clinic.
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Affiliation(s)
- P J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - C Roddie
- UCL Cancer Institute, London, UK; University College London Hospital NHS Foundation Trust, London, UK.
| | - P Bader
- Clinic for Children and Adolescents, University Children's Hospital, Frankfurt, Germany
| | - G W Basak
- Medical University of Warsaw, Department of Hematology, Transplantation and Internal Medicine, Warsaw, Poland
| | - H Bonig
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Service, Frankfurt, Germany
| | - C Bonini
- Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - C Chabannon
- Aix-Marseille université, Inserm CBT-1409, Institut Paoli-Calmettes, centre de thérapie cellulaire, unité de transplantation et de thérapie cellulaire, département de biologie du cancer, Marseille, France
| | - F Ciceri
- Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Franz-Josef-Strauss-Allee 11, University Hospital of Regensburg, Regensburg, Germany
| | - R Ellard
- Royal Marsden Hospital, Fulham Rd, London, UK
| | - F Sanchez-Guijo
- IBSAL-Hospital Universitario de Salamanca, CIC, Universidad de Salamanca, Salamanca, Spain
| | - U Jäger
- Clinical Department for Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - M Hildebrandt
- Department of Transfusion Medicine, Cell Therapeutics and Haemostaseology, LMU University Hospital Grosshadern, Munich
| | - M Hudecek
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M J Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, the Netherlands
| | - U Köhl
- Fraunhofer Institute for Cell Therapy and Immunology (IZI) and Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany; Institute of Cellular Therapeutics, Hannover Medical School, Hannover, Germany
| | - J Kuball
- Department of Hematology and Centre for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Mielke
- Karolinska Institutet and University Hospital, Department of Laboratory Medicine/Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Stockholm, Sweden
| | - M Mohty
- Hôpital Saint-Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - J Murray
- Christie Hospital NHS Trust, Manchester, UK
| | - A Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Rees
- University College London Hospital NHS Foundation Trust, London, UK; UCL Institute of Neurology, University College of London Hospitals NHS Foundation Trust, London, UK
| | - C Rioufol
- Hospices Civils de Lyon, UCBL1, EMR 3738 CICLY, Lyon, France
| | - R Saccardi
- Cell Therapy and Transfusion Medicine Department, Careggi University Hospital, Florence, Italy
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Subklewe
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Thieblemont
- AP-HP, Saint-Louis Hospital, Hemato-oncology, University of Paris, Paris, France
| | - M Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Á U Ispizua
- Department of Hematology, ICMHO, Hospital Clínic de Barcelona, Barcelona, Spain
| | - D Chen
- University College London Hospital NHS Foundation Trust, London, UK; Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Vrhovac
- Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - J G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg, Germany
| | - H Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - I Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France
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27
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Marzolini MAV, Neill L, O'Reilly M, Peggs KS, Roddie C. Lymphocyte morphology in a patient receiving CD19 chimeric antigen receptor T-cell therapy for mantle cell lymphoma. EJHaem 2022; 3:245-246. [PMID: 35846198 PMCID: PMC9175998 DOI: 10.1002/jha2.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Maria A V Marzolini
- Department of Haematology University College London Hospitals NHS Foundation Trust London UK
| | - Lorna Neill
- Department of Haematology University College London Hospitals NHS Foundation Trust London UK
| | - Maeve O'Reilly
- Department of Haematology University College London Hospitals NHS Foundation Trust London UK
| | - Karl S Peggs
- 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
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28
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Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related death worldwide. Most patients present with advanced disease, and current gold-standard management using tyrosine kinase inhibitors or immune checkpoint inhibitors (ICIs) offers modest clinical benefit. Cellular immune therapies targeting HCC are currently being tested in the laboratory and in clinical trials. Here, we review the landscape of cellular immunotherapy for HCC, defining antigenic targets, outlining the range of cell therapy products being applied in HCC (such as CAR-T and TCR-T), and exploring how advanced engineering solutions may further enhance this therapeutic approach.
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Affiliation(s)
- Harriet Roddy
- UCL Cancer Institute, London WC1E 6DD, UK; (H.R.); (T.M.)
| | - Tim Meyer
- UCL Cancer Institute, London WC1E 6DD, UK; (H.R.); (T.M.)
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
- Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - Claire Roddie
- UCL Cancer Institute, London WC1E 6DD, UK; (H.R.); (T.M.)
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
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29
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Hotblack A, Kokalaki EK, Palton MJ, Cheung GWK, Williams IP, Manzoor S, Grothier TI, Piapi A, Fiaccadori V, Wawrzyniecka P, Roddy HA, Agliardi G, Roddie C, Onuoha S, Thomas S, Cordoba S, Pule M. Tunable control of CAR T cell activity through tetracycline mediated disruption of protein-protein interaction. Sci Rep 2021; 11:21902. [PMID: 34754016 PMCID: PMC8578617 DOI: 10.1038/s41598-021-01418-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022] Open
Abstract
Chimeric antigen receptor (CAR) T cells are a promising form of cancer immunotherapy, although they are often associated with severe toxicities. Here, we present a split-CAR design incorporating separate antigen recognition and intracellular signaling domains. These exploit the binding between the tetracycline repressor protein and a small peptide sequence (TIP) to spontaneously assemble as a functional CAR. Addition of the FDA-approved, small molecule antibiotic minocycline, acts as an "off-switch" by displacing the signaling domain and down-tuning CAR T activity. Here we describe the optimization of this split-CAR approach to generate a CAR in which cytotoxicity, cytokine secretion and proliferation can be inhibited in a dose-dependent and reversible manner. Inhibition is effective during on-going CAR T cell activation and inhibits activation and tumor control in vivo. This work shows how optimization of split-CAR structure affects function and adds a novel design allowing easy CAR inhibition through an FDA-approved small molecule.
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Affiliation(s)
- Alastair Hotblack
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | | | - Morgan J Palton
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Gordon Weng-Kit Cheung
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Iwan P Williams
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | | | | | - Alice Piapi
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Valeria Fiaccadori
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Patrycja Wawrzyniecka
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Harriet A Roddy
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Giulia Agliardi
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | - Claire Roddie
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK
| | | | | | | | - Martin Pule
- Department of Haematology, UCL Cancer Institute, University College, 72 Huntley Street, London, WC1E 6DD, UK. .,Autolus Therapeutics, White City, London, UK.
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Kuhnl A, Mikhaeel G, Kirkwood A, Menne T, Frew J, Tholouli E, Patel A, Besley C, Beasley M, Latif A, O'Rourke N, Nicholson E, Alexander E, Chaganti S, Stevens A, Marzolini M, Johnson R, Sanderson R, Sivabalasingham S, Roddie C. Radiotherapy Bridging in Patients With R/R High-Grade Lymphoma Receiving CD19 CAR-T in the UK. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Mackenzie S, Shafat M, Roddy H, Hyare H, Neill L, Marzolini MAV, Gilhooley M, Marafioti T, Kara E, Sanchez E, Rees J, Lynch DS, Thomson K, Ardeshna KM, Laurence A, Peggs KS, O'Reilly M, Roddie C. Pembrolizumab for the treatment of progressive multifocal leukoencephalopathy following anti‐CD19 CAR‐T therapy: a case report. eJHaem 2021; 2:848-853. [PMID: 35845220 PMCID: PMC9281485 DOI: 10.1002/jha2.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is an opportunistic brain infection with few treatment options and poor survival when reversal of the underlying immune dysfunction is not achievable. JC polyomavirus reactivation resulting in PML can rarely complicate chimeric antigen receptor T‐cell (CAR‐T) therapy. We describe successful treatment of PML with Programmed death‐1 (PD‐1) blockade using pembrolizumab, 4 months following axicabtagene ciloleucel. Radiological features of immune reconstitution inflammatory syndrome without clinical deterioration were seen. Evidence of anti‐viral immune reconstitution by in vitro detection of JC‐specific T‐cells and sustained neurological recovery in this patient suggest PD‐1 blockade may be an effective treatment approach for PML post‐CAR‐T.
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Affiliation(s)
- Strachan Mackenzie
- UCL Cancer Institute Paul O'Gorman Building University College London London UK
- UCL Great Ormond Street Institute of Child Health University College London London UK
| | - Manar Shafat
- UCL Cancer Institute Paul O'Gorman Building University College London London UK
| | - Harriet Roddy
- UCL Cancer Institute Paul O'Gorman Building University College London London UK
| | - Harpreet Hyare
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
- Department of Radiology University College London Hospital NHS Foundation Trust London UK
| | - Lorna Neill
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Maria A. V. Marzolini
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Michael Gilhooley
- The Institute of Ophthalmology University College London Bath Street London UK
| | - Teresa Marafioti
- Department of Histopathology University College London 60 Whitfield Street London UK
| | - Eleanna Kara
- Department of Neuropathology National Hospital of Neurology and Neurosurgery University College London Hospital NHS Foundation Trust Queen Square London UK
| | - Emilie Sanchez
- Department of Virology University College London Hospital NHS Foundation Trust London UK
| | - Jeremy Rees
- Institute of Neurology National Hospital of Neurology and Neurosurgery University College London Queen Square London UK
| | - David S. Lynch
- Institute of Neurology National Hospital of Neurology and Neurosurgery University College London Queen Square London UK
| | - Kirsty Thomson
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Kirit M. Ardeshna
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Arian Laurence
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Karl S. Peggs
- UCL Cancer Institute Paul O'Gorman Building University College London London UK
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Maeve O'Reilly
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
| | - Claire Roddie
- UCL Cancer Institute Paul O'Gorman Building University College London London UK
- Department of Haematology University College London Hospital NHS Foundation Trust London UK
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32
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Amerikanou R, Neill L, Shafat M, Roddy H, Hyare H, Hughes S, Thomson K, Peggs KS, Laurence A, O'Reilly M, Roddie C. Multi-organ graft-versus-host disease after nivolumab for relapsed Hodgkin lymphoma: the role of plasma exchange. Lancet Haematol 2021; 8:e862. [PMID: 34715051 DOI: 10.1016/s2352-3026(21)00202-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Rodothea Amerikanou
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Lorna Neill
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manar Shafat
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Harriet Roddy
- Research Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Harpreet Hyare
- Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sian Hughes
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kirsty Thomson
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Karl S Peggs
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arian Laurence
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maeve 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
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33
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Roddie C, Dias J, O'Reilly MA, Abbasian M, Cadinanos-Garai A, Vispute K, Bosshard-Carter L, Mitsikakou M, Mehra V, Roddy H, Hartley JA, Spanswick V, Lowe H, Popova B, Clifton-Hadley L, Wheeler G, Olejnik J, Bloor A, Irvine D, Wood L, Marzolini MAV, Domning S, Farzaneh F, Lowdell MW, Linch DC, Pule MA, Peggs KS. Durable Responses and Low Toxicity After Fast Off-Rate CD19 Chimeric Antigen Receptor-T Therapy in Adults With Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia. J Clin Oncol 2021; 39:3352-3363. [PMID: 34464155 PMCID: PMC8791810 DOI: 10.1200/jco.21.00917] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prognosis for adult B-cell acute lymphoblastic leukemia (B-ALL) is poor, and there are currently no licensed CD19 chimeric antigen receptor (CAR) therapeutics. We developed a novel second-generation CD19-CAR (CAT19-41BB-Z) with a fast off rate, designed for more physiologic T-cell activation to reduce toxicity and improve engraftment. We describe the multicenter phase I ALLCAR19 (NCT02935257) study of autologous CAT19-41BB-Z CAR T cells (AUTO1) in relapsed or refractory (r/r) adult B-ALL. METHODS Patients age ≥ 16 years with r/r B-ALL were eligible. Primary outcomes were toxicity and manufacturing feasibility. Secondary outcomes were depth of response at 1 and 3 months, persistence of CAR-T, incidence and duration of hypogammaglobulinemia and B-cell aplasia, and event-free survival and overall survival at 1 and 2 years. RESULTS Twenty-five patients were leukapheresed, 24 products were manufactured, and 20 patients were infused with AUTO1. The median age was 41.5 years; 25% had prior blinatumomab, 50% prior inotuzumab ozogamicin, and 65% prior allogeneic stem-cell transplantation. At the time of preconditioning, 45% had ≥ 50% bone marrow blasts. No patients experienced ≥ grade 3 cytokine release syndrome; 3 of 20 (15%) experienced grade 3 neurotoxicity that resolved to ≤ grade 1 within 72 hours with steroids. Seventeen of 20 (85%) achieved minimal residual disease–negative complete response at month 1, and 3 of 17 underwent allogeneic stem-cell transplantation while in remission. The event-free survival at 6 and 12 months was 68.3% (42.4%-84.4%) and 48.3% (23.1%-69.7%), respectively. High-level expansion (Cmax 127,152 copies/µg genomic DNA) and durable CAR-T persistence were observed with B-cell aplasia ongoing in 15 of 20 patients at last follow-up. CONCLUSION AUTO1 demonstrates a tolerable safety profile, high remission rates, and excellent persistence in r/r adult B-ALL. Preliminary data support further development of AUTO1 as a stand-alone treatment for r/r adult B-ALL. Low toxicity & high durability CD19CAR T without allo-SCT offers new possibility for refractory adult B-ALL![]()
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Affiliation(s)
- Claire Roddie
- Cancer Institute, University College London, London, United Kingdom.,Department of Haematology, UCLH, London, United Kingdom
| | - Juliana Dias
- Cancer Institute, University College London, London, United Kingdom.,Royal Free Hospital London, NHS Foundation Trust, London, United Kingdom
| | | | - Mahnaz Abbasian
- Cancer Institute, University College London, London, United Kingdom
| | | | - Ketki Vispute
- Cancer Institute, University College London, London, United Kingdom
| | | | | | - Vedika Mehra
- Cancer Institute, University College London, London, United Kingdom
| | - Harriet Roddy
- Cancer Institute, University College London, London, United Kingdom
| | - John A Hartley
- Cancer Institute, University College London, London, United Kingdom.,UCL Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, London, United Kingdom
| | - Victoria Spanswick
- Cancer Institute, University College London, London, United Kingdom.,UCL Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, London, United Kingdom
| | - Helen Lowe
- Cancer Institute, University College London, London, United Kingdom.,UCL Experimental Cancer Medicine Centre Good Clinical Laboratory Practice Facility, London, United Kingdom
| | | | | | - Graham Wheeler
- CRUK UCL Cancer Trials Centre, London, United Kingdom.,Current address: Imperial Clinical Trials Unit, Imperial College London, London, United Kingdom
| | | | - Adrian Bloor
- The Christie Hospital, Manchester, United Kingdom
| | - David Irvine
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Leigh Wood
- Department of Haematology, UCLH, London, United Kingdom
| | | | - Sabine Domning
- King's College London, Cell and Gene Therapy - King's (CGTK), School of Cancer and Pharmaceutical Sciences, The Rayne Institute, London, United Kingdom
| | - Farzin Farzaneh
- King's College London, Cell and Gene Therapy - King's (CGTK), School of Cancer and Pharmaceutical Sciences, The Rayne Institute, London, United Kingdom
| | - Mark W Lowdell
- Cancer Institute, University College London, London, United Kingdom.,Royal Free Hospital London, NHS Foundation Trust, London, United Kingdom
| | - David C Linch
- Cancer Institute, University College London, London, United Kingdom
| | - Martin A Pule
- Cancer Institute, University College London, London, United Kingdom.,Autolus Ltd, London, United Kingdom
| | - Karl S Peggs
- Cancer Institute, University College London, London, United Kingdom.,Department of Haematology, UCLH, London, United Kingdom
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34
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Chan WY, Counsell N, de Tute R, De-Silva D, Phillips EH, Cavenagh J, Adedayo T, Braganca N, Roddie C, Streetly M, Schey S, Koh MBC, Crowe J, Morris TC, Cook G, Clifton-Hadley L, Rabin N, Owen RG, Popat R, Yong KL. Outcomes of relapse in patients with deferred autologous stem cell transplant after achieving at least very good partial response following bortezomib, adriamycin, dexamethasone chemotherapy for newly diagnosed multiple myeloma in the phase II PADIMAC trial. Br J Haematol 2021; 196:e33-e37. [PMID: 34636043 DOI: 10.1111/bjh.17903] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Yee Chan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Elizabeth H Phillips
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.,Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | | | - Toyin Adedayo
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | | | - Claire Roddie
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
| | | | | | | | | | | | - Gordon Cook
- Leeds Cancer Centre and Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | - Neil Rabin
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Rakesh Popat
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
| | - Kwee L Yong
- University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
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35
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Northend M, Wilson W, Osborne W, Fox CP, Davies AJ, El‐Sharkawi D, Phillips EH, Sim HW, Sadullah S, Shah N, Peng YY, Qureshi I, Addada J, Mora RF, Phillips N, Kuhnl A, Davies E, Wrench D, McKay P, Karpha I, Cowley A, Karim R, Challenor S, Singh V, Burton C, Auer R, Williams C, Broom A, Roddie C, Townsend W. POLATUZUMAB VEDOTIN WITH BENDAMUSTINE AND RITUXIMAB FOR RELAPSED/REFRACTORY HIGH‐GRADE B‐CELL LYMPHOMA: THE UK EXPERIENCE. Hematol Oncol 2021. [DOI: 10.1002/hon.86_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Northend
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
| | - W. Wilson
- Cancer Research UK & UCL Cancer Trials Centre Haematology Trials Team London UK
| | - W. Osborne
- The Newcastle‐upon‐Tyne Hospitals NHS Foundation Trust Department of Haematology Newcastle‐upon‐Tyne UK
| | - C. P. Fox
- Nottingham University Hospitals NHS Trust Department of Haematology Nottingham UK
| | - A. J Davies
- University of Southampton Southampton Cancer Research UK/NIHR Experimental Cancer Medicines Centre Southampton UK
| | - D. El‐Sharkawi
- The Royal Marsden NHS Foundation Trust Department of Haematology London UK
| | - E. H. Phillips
- University of Manchester The Christie NHS Foundation Trust Manchester UK
| | - H. W. Sim
- London North West University Healthcare NHS Trust Department of Haematology London UK
| | - S. Sadullah
- James Paget University Hospitals NHS Foundation Trust Department of Haematology Great Yarmouth UK
| | - N. Shah
- Norfolk & Norwich University Hospitals NHS Foundation Trust Department of Haematology Norwich UK
| | - Y. Y. Peng
- St George's University Hospital NHS Foundation Trust Department of Haematology London UK
| | - I. Qureshi
- University Hospitals Birmingham NHS Foundation Trust Department of Haematology Birmingham UK
| | - J. Addada
- University Hospitals of Derby & Burton NHS Foundation Trust Department of Haematology Derby UK
| | - R. F. Mora
- Nottingham University Hospitals NHS Trust Department of Haematology Nottingham UK
| | - N. Phillips
- University Hospital of North Midlands NHS Trust Department of Haematology Stoke‐on‐Trent UK
| | - A. Kuhnl
- King's College Hospital NHS Foundation Trust Department of Haematology London UK
| | - E. Davies
- Manchester University NHS Foundation Trust Department of Haematology London UK
| | - D. Wrench
- Guy's & St Thomas' Hospitals NHS Foundation Trust Department of Haematology London UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Department of Haematology Glasgow UK
| | - I. Karpha
- The Clatterbridge Cancer Centre NHS Foundation Trust Department of Haematology Liverpool UK
| | - A. Cowley
- East Sussex Healthcare NHS Trust Department of Haematology East Sussex UK
| | - R. Karim
- Dorset Healthcare University NHS Foundation Trust Department of Haematology Dorchester UK
| | - S. Challenor
- Royal Cornwall NHS Trust Department of Haematology Truro UK
| | - V. Singh
- Aintree University Hospital Department of Haematology Liverpool UK
| | - C. Burton
- Leeds Teaching Hospitals NHS Trust Department of Haematology Leeds UK
| | - R. Auer
- Bart's Health NHS Trust Department of Haemato‐Oncology London UK
| | - C. Williams
- Northumbria Healthcare NHS Foundation Trust Department of Haematology Hexham UK
| | - A. Broom
- Western General Hospital Department of Haematology Edinburgh UK
| | - C. Roddie
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
| | - W. Townsend
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
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36
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Popat R, Counsell N, de Tute R, De-Silva D, Phillips EH, Cavenagh JD, Adedayo T, Braganca N, Roddie C, Streetly M, Schey S, Koh MBC, Crowe J, Morris TC, Cook G, Smith P, Clifton-Hadley L, Rabin N, Owen R, Yong K. Using depth of response to stratify patients to front line Autologous Stem Cell Transplant: results of the phase II PADIMAC Myeloma Trial. Br J Haematol 2021; 193:e19-e22. [PMID: 33715154 DOI: 10.1111/bjh.17391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Rakesh Popat
- UCL Cancer Institute, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ruth de Tute
- Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Elizabeth H Phillips
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.,Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | | | - Toyin Adedayo
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | | | | | | | | | - Mickey B C Koh
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | - Gordon Cook
- Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Paul Smith
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | | | - Neil Rabin
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Roger Owen
- Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | | |
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37
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Nannini F, Parekh F, Wawrzyniecka P, Mekkaoui L, Righi M, Dastjerdi FV, Yeung J, Roddie C, Bai Y, Ma B, Ferrari M, Onuoha S, Chester K, Pule M. A primer set for the rapid isolation of scFv fragments against cell surface antigens from immunised rats. Sci Rep 2020; 10:19168. [PMID: 33154441 PMCID: PMC7644676 DOI: 10.1038/s41598-020-76069-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Antibody phage display is a powerful platform for discovery of clinically applicable high affinity monoclonal antibodies against a broad range of targets. Libraries generated from immunized animals offer the advantage of in vivo affinity-maturation of V regions prior to library generation. Despite advantages, few studies have described isolation of antibodies from rats using immune phage display. In our study, we describe a novel primer set, covering the full rat heavy chain variable and kappa light chain variable regions repertoire for the generation of an unbiased immune libraries. Since the immune repertoire of rats is poorly understood, we first performed a deep sequencing analysis of the V(D)J regions of VH and VLK genes, demonstrating the high abundance of IGVH2 and IGVH5 families for VH and IGVLK12 and IGVLK22 for VLK. The comparison of gene's family usage in naïve rats have been used to validate the frequency's distribution of the primer set, confirming the absence of PCR-based biases. The primers were used to generate and assemble a phage display library from human CD160-vaccinated rats. CD160 represents a valid therapeutic target as it has been shown to be expressed on chronic lymphocytic leukaemia cells and on the surface of newly formed vessels. We utilised a novel phage display panning strategy to isolate a high affinity pool (KD range: 0.399-233 nM) of CD160 targeting monoclonal antibodies. Subsequently, identified binders were tested for function as third generation Chimeric Antigen Receptors (CAR) T cells demonstrating specific cytolytic activity. Our novel primer set coupled with a streamlined strategy for phage display panning enable the rapid isolation and identification of high affinity antibodies from immunised rats. The therapeutic utility of these antibodies was demonstrated in CAR format.
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Affiliation(s)
- Francesco Nannini
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | - Farhaan Parekh
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | - Patrycja Wawrzyniecka
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | - Leila Mekkaoui
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | - Matteo Righi
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | | | - Jenny Yeung
- Research Department of Oncology, UCL Cancer Institute, London, UK
| | - Claire Roddie
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK
| | | | - Biao Ma
- Autolus Therapeutics, London, UK
| | | | | | - Kerry Chester
- Research Department of Oncology, UCL Cancer Institute, London, UK
| | - Martin Pule
- Research Department of Haematology, UCL Cancer Institute, 72 Huntley Street, London, WC1E 6DD, UK.
- Autolus Therapeutics, London, UK.
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38
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Fox TA, Troy-Barnes E, Kirkwood AA, Chan WY, Day JW, Chavda SJ, Kumar EA, David K, Tomkins O, Sanchez E, Scully M, Khwaja A, Lambert J, Singer M, Roddie C, Morris EC, Yong KL, Thomson KJ, Ardeshna KM. Response to 'Impact of immunosuppression on mortality in critically ill COVID-19 patients'. Br J Haematol 2020; 191:505-506. [PMID: 33103782 DOI: 10.1111/bjh.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas A Fox
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Ethan Troy-Barnes
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - Wei Y Chan
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - James W Day
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Selina J Chavda
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Emil A Kumar
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kate David
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Oliver Tomkins
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Mervyn Singer
- UCLH NIHR Biomedical Research Centre, London, UK.,Bloomsbury Institute of Intensive Care Medicine, UCL, London, UK
| | - Claire Roddie
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Emma C Morris
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK.,Department Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | - Kwee L Yong
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirsty J Thomson
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
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39
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Fox TA, Troy-Barnes E, Kirkwood AA, Chan WY, Day JW, Chavda SJ, Kumar EA, David K, Tomkins O, Sanchez E, Scully M, Khwaja A, Lambert J, Singer M, Roddie C, Morris EC, Yong KL, Thomson KJ, Ardeshna KM. Clinical outcomes and risk factors for severe COVID-19 in patients with haematological disorders receiving chemo- or immunotherapy. Br J Haematol 2020; 191:194-206. [PMID: 32678948 PMCID: PMC7405103 DOI: 10.1111/bjh.17027] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.
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Affiliation(s)
- Thomas A Fox
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Ethan Troy-Barnes
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Amy A Kirkwood
- CR UK & UCL Cancer Trials Centre, UCL Cancer Institute, UCL, London, UK
| | - Wei Yee Chan
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - James W Day
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK
| | - Selina J Chavda
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Emil A Kumar
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kate David
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Oliver Tomkins
- Department of Haematology, University College London NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London NHS Foundation Trust, London, UK
| | - Marie Scully
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Asim Khwaja
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK
| | - Jonathan Lambert
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Mervyn Singer
- UCLH NIHR Biomedical Research Centre, London, UK.,Bloomsbury Institute of Intensive Care Medicine, UCL, London, UK
| | - Claire Roddie
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Emma C Morris
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCL Institute of Immunity and Transplantation, UCL, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK.,Department Immunology, Royal Free London Hospitals NHS Foundation Trust, London, UK
| | - Kwee L Yong
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,Department of Haematology, UCL Cancer Institute, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirsty J Thomson
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
| | - Kirit M Ardeshna
- Department of Haematology, University College London NHS Foundation Trust, London, UK.,UCLH NIHR Biomedical Research Centre, London, UK
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40
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Shafat MS, Mehra V, Peggs KS, Roddie C. Cellular Therapeutic Approaches to Cytomegalovirus Infection Following Allogeneic Stem Cell Transplantation. Front Immunol 2020; 11:1694. [PMID: 32849591 PMCID: PMC7411136 DOI: 10.3389/fimmu.2020.01694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/25/2020] [Indexed: 12/31/2022] Open
Abstract
Cytomegalovirus (CMV) infection is common following allogeneic hematopoietic stem cell transplant (HSCT) and is a major cause of morbidity and increased mortality. Whilst pharmacotherapy can be effective in the prevention and treatment of CMV, these agents are often expensive, toxic and in some cases ineffective due to viral resistance mechanisms. Immunotherapeutic approaches are compelling and early clinical trials of adoptively transferred donor-derived virus-specific T (VST) cells against CMV have demonstrated efficacy. However, significant logistical challenges limit their broad application. Strategies to optimize VST manufacture and cell banking alongside scientific developments to enhance efficacy whilst minimizing toxicity are ongoing. This review will discuss the development of CMV-specific T-cell therapies, the challenges of widespread delivery of VSTs for CMV and explore how VST therapy can change outcomes in CMV infection following HSCT.
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Affiliation(s)
- Manar S Shafat
- Research Department of Haematology, UCL Cancer Institute, University College London, Cancer Institute, London, United Kingdom
| | - Vedika Mehra
- Research Department of Haematology, UCL Cancer Institute, University College London, Cancer Institute, London, United Kingdom
| | - Karl S Peggs
- Research Department of Haematology, UCL Cancer Institute, University College London, Cancer Institute, London, United Kingdom.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Claire Roddie
- Research Department of Haematology, UCL Cancer Institute, University College London, Cancer Institute, London, United Kingdom.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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41
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O'Reilly M, Roddie C, Marzolini MAV, Rodriguez-Justo M, Pomplun S, Pule M, Peggs KS. Trafficking of CAR T cells to sites of subclinical leukaemia cutis. Lancet Oncol 2020; 21:e179. [PMID: 32135121 DOI: 10.1016/s1470-2045(19)30861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Maeve O'Reilly
- Department of Haematology, University College London Cancer Institute, London, UK. maeve.o'
| | - Claire Roddie
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Maria A V Marzolini
- Department of Haematology, University College London Cancer Institute, London, UK
| | | | - Sabine Pomplun
- Department of Histopathology, University College London Cancer Institute, London, UK
| | - Martin Pule
- Department of Haematology, University College London Cancer Institute, London, UK
| | - Karl S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
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42
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Abstract
Chimeric antigen receptor (CAR) T-cell therapy is one of the most innovative therapies for haematological malignancies to emerge in a generation. Clinical studies have shown that a single dose of CAR T-cells can deliver durable clinical remissions for some patients with B-cell cancers where conventional therapies have failed.A significant complication of CAR therapy is the immune effector cell-associated neurotoxicity syndrome (ICANS). This syndrome presents a continuum from mild tremor to cerebral oedema and in a minority of cases, death. Management of ICANS is mainly supportive, with a focus on seizure prevention and attenuation of the immune system, often using corticosteroids. Parallel investigation to exclude other central nervous system pathologies (infection, disease progression) is critical. In this review, we discuss current paradigms around CAR T-cell therapy, with a focus on appropriate investigation and management of ICANS.
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Affiliation(s)
- Lorna Neill
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Jeremy Rees
- Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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43
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Ghosh AK, Chen DH, Guha A, Mackenzie S, Walker JM, Roddie C. CAR T Cell Therapy-Related Cardiovascular Outcomes and Management: Systemic Disease or Direct Cardiotoxicity? JACC CardioOncol 2020; 2:97-109. [PMID: 34396213 PMCID: PMC8352125 DOI: 10.1016/j.jaccao.2020.02.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 12/23/2022] Open
Abstract
CD19-specific chimeric antigen receptor (CAR) T cell therapies have shown remarkable early success in highly refractory and relapsing hematological malignancies. However, this potent therapy is accompanied by significant toxicity. Cytokine release syndrome and neurotoxicity are the most widely reported, but the true extent and characteristics of cardiovascular toxicity remain poorly understood. Thus far, adverse cardiovascular effects observed include sinus tachycardia and other arrhythmias, left ventricular systolic dysfunction, profound hypotension, and shock requiring inotropic support. The literature regarding cardiovascular toxicities remains sparse; prospective studies are needed to define the cardiac safety of CAR T cell therapies to optimally harness their potential. This review summarizes the current understanding of the potential cardiovascular toxicities of CD19-specific CAR T cell therapies, outlines a proposed cardiac surveillance protocol for patients receiving this new treatment, and provides a roadmap of the future direction of cardio-oncology research in this area.
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Affiliation(s)
- Arjun K. Ghosh
- Cardio-Oncology Service, Bart’s Heart Centre, St Bartholomew’s Hospital West Smithfield, London, United Kingdom
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom
| | - Daniel H. Chen
- Cardio-Oncology Service, Bart’s Heart Centre, St Bartholomew’s Hospital West Smithfield, London, United Kingdom
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Division of Cardiology, Case Western Reserve University, Harrington Heart and Vascular Institute, Ashland, Ohio, USA
| | - Strachan Mackenzie
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - J. Malcolm Walker
- Hatter Cardiovascular Institute, Institute of Cardiovascular Science UCL, University College London Hospital, London, United Kingdom
| | - Claire Roddie
- Department of Haematology, University College London Hospital, London, United Kingdom
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44
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Marzolini MAV, Jaunmuktane Z, Roddie C, O'Reilly M, Chiodini P, Peggs KS. Toxoplasmosis initially presenting as neurological sequelae of chimeric antigen receptor T-cell therapy. The Lancet Infectious Diseases 2019; 19:788. [DOI: 10.1016/s1473-3099(19)30119-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 11/25/2022]
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45
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Roddie C, O'Reilly M, Dias Alves Pinto J, Vispute K, Lowdell M. Manufacturing chimeric antigen receptor T cells: issues and challenges. Cytotherapy 2019; 21:327-340. [PMID: 30685216 DOI: 10.1016/j.jcyt.2018.11.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
Clinical trials of adoptively transferred CD19 chimeric antigen receptor (CAR) T cells have delivered unprecedented responses in patients with relapsed refractory B-cell malignancy. These results have prompted Food and Drug Administration (FDA) approval of two CAR T-cell products in this high-risk patient population. The widening range of indications for CAR T-cell therapy and increasing patient numbers present a significant logistical challenge to manufacturers aiming for reproducible delivery systems for high-quality clinical CAR T-cell products. This review discusses current and novel CAR T-cell processing methodologies and the quality control systems needed to meet the increasing clinical demand for these exciting new therapies.
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Affiliation(s)
- Claire Roddie
- Research Department of Haematology, University College London, London, UK; Department of Haematology, University College London Hospitals National Health Service (NHS) Foundation Trust, London.
| | - Maeve O'Reilly
- Research Department of Haematology, University College London, London, UK; Department of Haematology, University College London Hospitals National Health Service (NHS) Foundation Trust, London
| | | | - Ketki Vispute
- Research Department of Haematology, University College London, London, UK
| | - Mark Lowdell
- Research Department of Haematology, University College London, London, UK
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46
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Chapman MA, Sive J, Ambrose J, Roddie C, Counsell N, Lach A, Abbasian M, Popat R, Cavenagh JD, Oakervee H, Streetly MJ, Schey S, Koh M, Willis F, Virchis AE, Crowe J, Quinn MF, Cook G, Crawley CR, Pratt G, Cook M, Braganza N, Adedayo T, Smith P, Clifton-Hadley L, Owen RG, Sonneveld P, Keats JJ, Herrero J, Yong K. RNA-seq of newly diagnosed patients in the PADIMAC study leads to a bortezomib/lenalidomide decision signature. Blood 2018; 132:2154-2165. [PMID: 30181174 PMCID: PMC6310235 DOI: 10.1182/blood-2018-05-849893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/28/2018] [Indexed: 01/29/2023] Open
Abstract
Improving outcomes in multiple myeloma will involve not only development of new therapies but also better use of existing treatments. We performed RNA sequencing on samples from newly diagnosed patients enrolled in the phase 2 PADIMAC (Bortezomib, Adriamycin, and Dexamethasone Therapy for Previously Untreated Patients with Multiple Myeloma: Impact of Minimal Residual Disease in Patients with Deferred ASCT) study. Using synthetic annealing and the large margin nearest neighbor algorithm, we developed and trained a 7-gene signature to predict treatment outcome. We tested the signature in independent cohorts treated with bortezomib- and lenalidomide-based therapies. The signature was capable of distinguishing which patients would respond better to which regimen. In the CoMMpass data set, patients who were treated correctly according to the signature had a better progression-free survival (median, 20.1 months vs not reached; hazard ratio [HR], 0.40; confidence interval [CI], 0.23-0.72; P = .0012) and overall survival (median, 30.7 months vs not reached; HR, 0.41; CI, 0.21-0.80; P = .0049) than those who were not. Indeed, the outcome for these correctly treated patients was noninferior to that for those treated with combined bortezomib, lenalidomide, and dexamethasone, arguably the standard of care in the United States but not widely available elsewhere. The small size of the signature will facilitate clinical translation, thus enabling more targeted drug regimens to be delivered in myeloma.
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Affiliation(s)
- Michael A Chapman
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- Department of Haematology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Jonathan Sive
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - John Ambrose
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Claire Roddie
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Anna Lach
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Mahnaz Abbasian
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Rakesh Popat
- Department of Haematology, University College London Hospitals, London, United Kingdom
| | - Jamie D Cavenagh
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Heather Oakervee
- Department of Haemato-oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Matthew J Streetly
- Department of Haematology, Guys and St. Thomas' Hospital, London, United Kingdom
| | - Stephen Schey
- Department of Haematology, Kings College Hospital, London, United Kingdom
| | - Mickey Koh
- Department of Haematology, St. George's Hospital, London, United Kingdom
| | - Fenella Willis
- Department of Haematology, St. George's Hospital, London, United Kingdom
| | - Andres E Virchis
- Department of Haematology, Royal Free London, Barnet and Chase Farm Hospitals, London, United Kingdom
| | - Josephine Crowe
- Department of Haematology, Royal United Hospitals Bath, Bath, United Kingdom
| | - Michael F Quinn
- Department of Haematology, Belfast City Hospital, Belfast, United Kingdom
| | - Gordon Cook
- Department of Haematology, St. James's University Hospital, Leeds, United Kingdom
| | - Charles R Crawley
- Department of Haematology, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Guy Pratt
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Mark Cook
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Nivette Braganza
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Toyin Adedayo
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St. James' University Hospital, Leeds, United Kingdom
| | | | - Jonathan J Keats
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, Phoenix, AZ
| | - Javier Herrero
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Kwee Yong
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
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Arce Vargas F, Furness AJS, Litchfield K, Joshi K, Rosenthal R, Ghorani E, Solomon I, Lesko MH, Ruef N, Roddie C, Henry JY, Spain L, Ben Aissa A, Georgiou A, Wong YNS, Smith M, Strauss D, Hayes A, Nicol D, O'Brien T, Mårtensson L, Ljungars A, Teige I, Frendéus B, Pule M, Marafioti T, Gore M, Larkin J, Turajlic S, Swanton C, Peggs KS, Quezada SA. Fc Effector Function Contributes to the Activity of Human Anti-CTLA-4 Antibodies. Cancer Cell 2018; 33:649-663.e4. [PMID: 29576375 PMCID: PMC5904288 DOI: 10.1016/j.ccell.2018.02.010] [Citation(s) in RCA: 393] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 12/13/2017] [Accepted: 02/15/2018] [Indexed: 12/31/2022]
Abstract
With the use of a mouse model expressing human Fc-gamma receptors (FcγRs), we demonstrated that antibodies with isotypes equivalent to ipilimumab and tremelimumab mediate intra-tumoral regulatory T (Treg) cell depletion in vivo, increasing the CD8+ to Treg cell ratio and promoting tumor rejection. Antibodies with improved FcγR binding profiles drove superior anti-tumor responses and survival. In patients with advanced melanoma, response to ipilimumab was associated with the CD16a-V158F high affinity polymorphism. Such activity only appeared relevant in the context of inflamed tumors, explaining the modest response rates observed in the clinical setting. Our data suggest that the activity of anti-CTLA-4 in inflamed tumors may be improved through enhancement of FcγR binding, whereas poorly infiltrated tumors will likely require combination approaches.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/pharmacology
- CTLA-4 Antigen/antagonists & inhibitors
- Cell Line, Tumor
- Female
- Humans
- Ipilimumab/administration & dosage
- Ipilimumab/pharmacology
- Melanoma/drug therapy
- Melanoma/genetics
- Melanoma/immunology
- Mice
- Polymorphism, Single Nucleotide
- Receptors, IgG/genetics
- Receptors, IgG/metabolism
- T-Lymphocytes, Regulatory/immunology
- Treatment Outcome
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Frederick Arce Vargas
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Andrew J S Furness
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Kevin Litchfield
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Kroopa Joshi
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK; The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Rachel Rosenthal
- Bill Lyons Informatics Centre, UCL Cancer Institute, London WC1E 6DD, UK; Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London WC1E 6DD, UK
| | - Ehsan Ghorani
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Isabelle Solomon
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Marta H Lesko
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Nora Ruef
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Claire Roddie
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Jake Y Henry
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Lavinia Spain
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Assma Ben Aissa
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Andrew Georgiou
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Yien Ning Sophia Wong
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Myles Smith
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Dirk Strauss
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Andrew Hayes
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - David Nicol
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Tim O'Brien
- Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | | | | | | | | | - Martin Pule
- Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK
| | - Teresa Marafioti
- Department of Cellular Pathology, University College London Hospital, London NW1 2BU, UK
| | - Martin Gore
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Samra Turajlic
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Charles Swanton
- Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, London NW1 1AT, UK; Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London WC1E 6DD, UK; Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, London WC1E 6DD, UK
| | - Karl S Peggs
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
| | - Sergio A Quezada
- Cancer Immunology Unit, University College London (UCL) Cancer Institute, London WC1E 6DD, UK; Research Department of Haematology, UCL Cancer Institute, London WC1E 6DD, UK.
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48
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Abstract
Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections following allogeneic hematopoietic stem cell transplantation (HSCT) are a major cause of morbidity and mortality. Early clinical trials demonstrate that adoptive transfer of donor-derived virus-specific T cells to restore virus-specific immunity is an effective strategy to control CMV and EBV infection after HSCT, conferring protection in 70%-90% of patients. The field has evolved rapidly to develop solutions to some of the manufacturing challenges identified in early clinical studies, such as prolonged in vitro culture, optimization of the purity of the virus-specific T cell product, the potential limitations of targeting a single viral antigen, and how to manage the patient with a virus-naive donor. This Review both discusses the seminal early studies and explores cutting-edge novel technologies that broaden the feasibility of and the scope for delivering virus-specific T cells to patients after HSCT.
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Affiliation(s)
- Claire Roddie
- Department of Haematology, University College London Cancer Institute, London, United Kingdom.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Karl S Peggs
- Department of Haematology, University College London Cancer Institute, London, United Kingdom.,Department of Haematology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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49
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Abstract
Ipilimumab is a fully human immunoglobulin subclass G1 anticytotoxic-T-lymphocyte-antigen-4 monoclonal antibody. It has been approved by the US Food and Drug Administration (FDA) and the European Medicines Agency for use in advanced melanoma following clear evidence of survival benefit in randomized Phase III studies. It is also under investigation as a treatment for other solid tumors such as renal cell, lung, and prostate cancers. The purported mechanism of antitumor activity of ipilimumab is through T-cell activation, and the side effect profile reflects this. Immune-related adverse events (irAEs) affect 60% of treated patients and 15% are defined as severe. Fortunately, most irAEs are reversible with early diagnosis and correct management. FDA approval of ipilimumab is dependent on the careful execution of a risk evaluation and mitigation strategy, with the aim of increasing awareness amongst patients and clinicians of the immunological risks of treatment, and providing algorithms for management of irAEs as they develop. Ipilimumab is one of the first immunotherapies to become widely available in the setting of solid tumors, and ongoing research aims to elucidate optimal dosing, optimal scheduling, and expanded access to ipilimumab as an adjuvant or maintenance therapy where appropriate. The identification of clinical correlates or biomarkers to identify those likely to benefit from this high-cost therapy is a top priority.
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Affiliation(s)
- Claire Roddie
- UCL Cancer Institute, Department of Hematology, London, UK
| | - Karl S Peggs
- UCL Cancer Institute, Department of Hematology, London, UK
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50
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Simpson TR, Li F, Montalvo-Ortiz W, Sepulveda MA, Bergerhoff K, Arce F, Roddie C, Henry JY, Yagita H, Wolchok JD, Peggs KS, Ravetch JV, Allison JP, Quezada SA. Fc-dependent depletion of tumor-infiltrating regulatory T cells co-defines the efficacy of anti-CTLA-4 therapy against melanoma. ACTA ACUST UNITED AC 2013; 210:1695-710. [PMID: 23897981 PMCID: PMC3754863 DOI: 10.1084/jem.20130579] [Citation(s) in RCA: 1059] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anti–CTLA-4 antibody induces selective depletion of T reg cells within tumor lesions in a manner that is dependent on the presence of Fc gamma receptor-expressing macrophages within the tumor microenvironment. Treatment with monoclonal antibody specific for cytotoxic T lymphocyte–associated antigen 4 (CTLA-4), an inhibitory receptor expressed by T lymphocytes, has emerged as an effective therapy for the treatment of metastatic melanoma. Although subject to debate, current models favor a mechanism of activity involving blockade of the inhibitory activity of CTLA-4 on both effector (T eff) and regulatory (T reg) T cells, resulting in enhanced antitumor effector T cell activity capable of inducing tumor regression. We demonstrate, however, that the activity of anti–CTLA-4 antibody on the T reg cell compartment is mediated via selective depletion of T reg cells within tumor lesions. Importantly, T reg cell depletion is dependent on the presence of Fcγ receptor–expressing macrophages within the tumor microenvironment, indicating that T reg cells are depleted in trans in a context-dependent manner. Our results reveal further mechanistic insight into the activity of anti-CTLA-4–based cancer immunotherapy, and illustrate the importance of specific features of the local tumor environment on the final outcome of antibody-based immunomodulatory therapies.
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Affiliation(s)
- Tyler R Simpson
- Department of Immunology, M D Anderson Cancer Center, Houston, TX 77030, USA
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