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Ghorashian S, Lucchini G, Richardson R, Nguyen K, Terris C, Guvenel A, Oporto-Espuelas M, Yeung J, Pinner D, Chu J, Williams L, Ko KY, Walding C, Watts K, Inglott S, Thomas R, Connor C, Adams S, Gravett E, Gilmour K, Lal A, Kunaseelan S, Popova B, Lopes A, Ngai Y, Hackshaw A, Kokalaki E, Carulla MB, Mullanfiroze K, Lazareva A, Pavasovic V, Rao A, Bartram J, Vora A, Chiesa R, Silva J, Rao K, Bonney D, Wynn R, Pule M, Hough R, Amrolia PJ. CD19/CD22 targeting with cotransduced CAR T cells to prevent antigen-negative relapse after CAR T-cell therapy for B-cell ALL. Blood 2024; 143:118-123. [PMID: 37647647 DOI: 10.1182/blood.2023020621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/31/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT CD19-negative relapse is a leading cause of treatment failure after chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia. We investigated a CAR T-cell product targeting CD19 and CD22 generated by lentiviral cotransduction with vectors encoding our previously described fast-off rate CD19 CAR (AUTO1) combined with a novel CD22 CAR capable of effective signaling at low antigen density. Twelve patients with advanced B-cell acute lymphoblastic leukemia were treated (CARPALL [Immunotherapy with CD19/22 CAR Redirected T Cells for High Risk/Relapsed Paediatric CD19+ and/or CD22+ Acute Lymphoblastic Leukaemia] study, NCT02443831), a third of whom had failed prior licensed CAR therapy. Toxicity was similar to that of AUTO1 alone, with no cases of severe cytokine release syndrome. Of 12 patients, 10 (83%) achieved a measurable residual disease (MRD)-negative complete remission at 2 months after infusion. Of 10 responding patients, 5 had emergence of MRD (n = 2) or relapse (n = 3) with CD19- and CD22-expressing disease associated with loss of CAR T-cell persistence. With a median follow-up of 8.7 months, there were no cases of relapse due to antigen-negative escape. Overall survival was 75% (95% confidence interval [CI], 41%-91%) at 6 and 12 months. The 6- and 12-month event-free survival rates were 75% (95% CI, 41%-91%) and 60% (95% CI, 23%-84%), respectively. These data suggest dual targeting with cotransduction may prevent antigen-negative relapse after CAR T-cell therapy.
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Affiliation(s)
- Sara Ghorashian
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
- Department of Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Giovanna Lucchini
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rachel Richardson
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kyvi Nguyen
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Craig Terris
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aleks Guvenel
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Macarena Oporto-Espuelas
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jenny Yeung
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Danielle Pinner
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jan Chu
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Lindsey Williams
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ka-Yuk Ko
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Chloe Walding
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Kelly Watts
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Sarah Inglott
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rebecca Thomas
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Christopher Connor
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Stuart Adams
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Emma Gravett
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Cell Therapy and Immunology Laboratory, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Alka Lal
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Bilyana Popova
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Andre Lopes
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Milena Balasch Carulla
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Khushnuma Mullanfiroze
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Arina Lazareva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Anupama Rao
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Robert Chiesa
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Juliana Silva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kanchan Rao
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Denise Bonney
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Robert Wynn
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Rachael Hough
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Persis J Amrolia
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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2
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Benjamin R, Graham C, Yallop D, Jozwik A, Mirci-Danicar OC, Lucchini G, Pinner D, Jain N, Kantarjian H, Boissel N, Maus MV, Frigault MJ, Baruchel A, Mohty M, Gianella-Borradori A, Binlich F, Balandraud S, Vitry F, Thomas E, Philippe A, Fouliard S, Dupouy S, Marchiq I, Almena-Carrasco M, Ferry N, Arnould S, Konto C, Veys P, Qasim W. Genome-edited, donor-derived allogeneic anti-CD19 chimeric antigen receptor T cells in paediatric and adult B-cell acute lymphoblastic leukaemia: results of two phase 1 studies. Lancet 2020; 396:1885-1894. [PMID: 33308471 DOI: 10.1016/s0140-6736(20)32334-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Genome-edited donor-derived allogeneic anti-CD19 chimeric antigen receptor (CAR) T cells offer a novel form of CAR-T-cell product that is available for immediate clinical use, thereby broadening access and applicability. UCART19 is one such product investigated in children and adults with relapsed or refractory B-cell acute lymphoblastic leukaemia. Two multicentre phase 1 studies aimed to investigate the feasibility, safety, and antileukaemic activity of UCART19 in children and adults with relapsed or refractory B-cell acute lymphoblastic leukaemia. METHODS We enrolled paediatric or adult patients in two ongoing, multicentre, phase 1 clinical trials to evaluate the safety and antileukaemic activity of UCART19. All patients underwent lymphodepletion with fludarabine and cyclophosphamide with or without alemtuzumab, then children received UCART19 at 1·1-2·3 × 106 cells per kg and adults received UCART19 doses of 6 × 106 cells, 6-8 × 107 cells, or 1·8-2·4 × 108 cells in a dose-escalation study. The primary outcome measure was adverse events in the period between first infusion and data cutoff. These studies were registered at ClinicalTrials.gov, NCT02808442 and NCT02746952. FINDINGS Between June 3, 2016, and Oct 23, 2018, seven children and 14 adults were enrolled in the two studies and received UCART19. Cytokine release syndrome was the most common adverse event and was observed in 19 patients (91%); three (14%) had grade 3-4 cytokine release syndrome. Other adverse events were grade 1 or 2 neurotoxicity in eight patients (38%), grade 1 acute skin graft-versus-host disease in two patients (10%), and grade 4 prolonged cytopenia in six patients (32%). Two treatment-related deaths occurred; one caused by neutropenic sepsis in a patient with concurrent cytokine release syndrome and one from pulmonary haemorrhage in a patient with persistent cytopenia. 14 (67%) of 21 patients had a complete response or complete response with incomplete haematological recovery 28 days after infusion. Patients not receiving alemtuzumab (n=4) showed no UCART19 expansion or antileukaemic activity. The median duration of response was 4·1 months with ten (71%) of 14 responders proceeding to a subsequent allogeneic stem-cell transplant. Progression-free survival at 6 months was 27%, and overall survival was 55%. INTERPRETATION These two studies show, for the first time, the feasibility of using allogeneic, genome-edited CAR T cells to treat patients with aggressive leukaemia. UCART19 exhibited in-vivo expansion and antileukaemic activity with a manageable safety profile in heavily pretreated paediatric and adult patients with relapsed or refractory B-cell acute lymphoblastic leukaemia. The results this study are an encouraging step forward for the field of allogeneic CAR T cells, and UCART19 offers the opportunity to treat patients with rapidly progressive disease and where autologous CAR-T-cell therapy is unavailable. FUNDING Servier.
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Affiliation(s)
- Reuben Benjamin
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK.
| | - Charlotte Graham
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | - Deborah Yallop
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Agnieszka Jozwik
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cancer and Pharmaceutical Sciences, Kings College London, London, UK
| | - Oana C Mirci-Danicar
- Infection, Immunity & Inflammation Department, Great Ormond Street Hospital, London, UK
| | - Giovanna Lucchini
- Infection, Immunity & Inflammation Department, Great Ormond Street Hospital, London, UK
| | - Danielle Pinner
- Infection, Immunity & Inflammation Department, Great Ormond Street Hospital, London, UK
| | - Nitin Jain
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Boissel
- Department of Hematology, Hôpital Saint Louis, Paris, France
| | - Marcela V Maus
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Frigault
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - André Baruchel
- Department of Pediatric Hematology, K Hôpital Universitaire Robert Debré, Paris, France
| | - Mohamad Mohty
- INSERM UMRS 938, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | | | - Florence Binlich
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | - Fabien Vitry
- Institut de Recherches Internationales Servier, Suresnes, France; Laboratoires Davolterra, Paris, France
| | - Elisabeth Thomas
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Anne Philippe
- Institut de Recherches Internationales Servier, Suresnes, France; Pfizer, Paris, France
| | - Sylvain Fouliard
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Sandra Dupouy
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | | | - Nicolas Ferry
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | - Cyril Konto
- Allogene Therapeutics, South San Francisco, CA, USA
| | - Paul Veys
- Infection, Immunity & Inflammation Department, Great Ormond Street Hospital, London, UK
| | - Waseem Qasim
- Infection, Immunity & Inflammation Department, Great Ormond Street Hospital, London, UK
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3
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Chiesa R, Standing JF, Winter R, Nademi Z, Chu J, Pinner D, Kloprogge F, McLellen S, Amrolia PJ, Rao K, Lucchini G, Silva J, Ciocarlie O, Lazareva A, Gennery AR, Doncheva B, Cant AJ, Hambleton S, Flood T, Rogerson E, Devine K, Prunty H, Heales S, Veys P, Slatter M. Proposed Therapeutic Range of Treosulfan in Reduced Toxicity Pediatric Allogeneic Hematopoietic Stem Cell Transplant Conditioning: Results From a Prospective Trial. Clin Pharmacol Ther 2019; 108:264-273. [PMID: 31701524 PMCID: PMC7484914 DOI: 10.1002/cpt.1715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/07/2019] [Accepted: 10/28/2019] [Indexed: 12/18/2022]
Abstract
Treosulfan is given off‐label in pediatric allogeneic hematopoietic stem cell transplant. This study investigated treosulfan's pharmacokinetics (PKs), efficacy, and safety in a prospective trial. Pediatric patients (n = 87) receiving treosulfan‐fludarabine conditioning were followed for at least 1 year posttransplant. PKs were described with a two‐compartment model. During follow‐up, 11 of 87 patients died and 12 of 87 patients had low engraftment (≤ 20% myeloid chimerism). For each increase in treosulfan area under the curve from zero to infinity (AUC(0‐∞)) of 1,000 mg hour/L the hazard ratio (95% confidence interval) for mortality increase was 1.46 (1.23–1.74), and the hazard ratio for low engraftment was 0.61 (0.36–1.04). A cumulative AUC(0‐∞) of 4,800 mg hour/L maximized the probability of success (> 20% engraftment and no mortality) at 82%. Probability of success with AUC(0‐∞) between 80% and 125% of this target were 78% and 79%. Measuring PK at the first dose and individualizing the third dose may be required in nonmalignant disease.
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Affiliation(s)
- Robert Chiesa
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Infection, Immunity, and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Robert Winter
- Chemical Pathology Department, Great Ormond Street Hospital for Children,, NHS Foundation Trust, London, UK
| | - Zohreh Nademi
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Chu
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Danielle Pinner
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Frank Kloprogge
- Institute for Global Health, University College London, London, UK
| | - Susan McLellen
- Clinical Biochemistry, Integrated Laboratory Medicine Directorate, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Persis J Amrolia
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Infection, Immunity, and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Kanchan Rao
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Juliana Silva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Oana Ciocarlie
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Arina Lazareva
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Andrew R Gennery
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bilyana Doncheva
- Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Andrew J Cant
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sophie Hambleton
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Terence Flood
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth Rogerson
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirsty Devine
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Prunty
- Chemical Pathology Department, Great Ormond Street Hospital for Children,, NHS Foundation Trust, London, UK
| | - Simon Heales
- Chemical Pathology Department, Great Ormond Street Hospital for Children,, NHS Foundation Trust, London, UK
| | - Paul Veys
- Bone Marrow Transplantation Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Infection, Immunity, and Inflammation, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mary Slatter
- Bone Marrow Transplantation Department, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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4
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Ghorashian S, Kramer AM, Onuoha S, Wright G, Bartram J, Richardson R, Albon SJ, Casanovas-Company J, Castro F, Popova B, Villanueva K, Yeung J, Vetharoy W, Guvenel A, Wawrzyniecka PA, Mekkaoui L, Cheung GWK, Pinner D, Chu J, Lucchini G, Silva J, Ciocarlie O, Lazareva A, Inglott S, Gilmour KC, Ahsan G, Ferrari M, Manzoor S, Champion K, Brooks T, Lopes A, Hackshaw A, Farzaneh F, Chiesa R, Rao K, Bonney D, Samarasinghe S, Goulden N, Vora A, Veys P, Hough R, Wynn R, Pule MA, Amrolia PJ. Enhanced CAR T cell expansion and prolonged persistence in pediatric patients with ALL treated with a low-affinity CD19 CAR. Nat Med 2019; 25:1408-1414. [DOI: 10.1038/s41591-019-0549-5] [Citation(s) in RCA: 266] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
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5
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Qasim W, Zhan H, Samarasinghe S, Adams S, Amrolia P, Stafford S, Butler K, Rivat C, Wright G, Somana K, Ghorashian S, Pinner D, Ahsan G, Gilmour K, Lucchini G, Inglott S, Mifsud W, Chiesa R, Peggs KS, Chan L, Farzeneh F, Thrasher AJ, Vora A, Pule M, Veys P. Molecular remission of infant B-ALL after infusion of universal TALEN gene-edited CAR T cells. Sci Transl Med 2018; 9:9/374/eaaj2013. [PMID: 28123068 DOI: 10.1126/scitranslmed.aaj2013] [Citation(s) in RCA: 609] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/13/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
Autologous T cells engineered to express chimeric antigen receptor against the B cell antigen CD19 (CAR19) are achieving marked leukemic remissions in early-phase trials but can be difficult to manufacture, especially in infants or heavily treated patients. We generated universal CAR19 (UCART19) T cells by lentiviral transduction of non-human leukocyte antigen-matched donor cells and simultaneous transcription activator-like effector nuclease (TALEN)-mediated gene editing of T cell receptor α chain and CD52 gene loci. Two infants with relapsed refractory CD19+ B cell acute lymphoblastic leukemia received lymphodepleting chemotherapy and anti-CD52 serotherapy, followed by a single-dose infusion of UCART19 cells. Molecular remissions were achieved within 28 days in both infants, and UCART19 cells persisted until conditioning ahead of successful allogeneic stem cell transplantation. This bridge-to-transplantation strategy demonstrates the therapeutic potential of gene-editing technology.
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Affiliation(s)
- Waseem Qasim
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK. .,Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Hong Zhan
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sujith Samarasinghe
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Stuart Adams
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Persis Amrolia
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.,Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sian Stafford
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Katie Butler
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Christine Rivat
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Gary Wright
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Kathy Somana
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sara Ghorashian
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Danielle Pinner
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Gul Ahsan
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Kimberly Gilmour
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Giovanna Lucchini
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sarah Inglott
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - William Mifsud
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Robert Chiesa
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Karl S Peggs
- Cancer Institute, University College London, London WC1E 6DD, UK
| | - Lucas Chan
- Division of Cancer Studies, Department of Haematological Medicine, King's College London, London SE5 9NU, UK
| | - Farzin Farzeneh
- Division of Cancer Studies, Department of Haematological Medicine, King's College London, London SE5 9NU, UK
| | - Adrian J Thrasher
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Ajay Vora
- Sheffield Children's Hospital, Sheffield S10 2TH, UK
| | - Martin Pule
- Cancer Institute, University College London, London WC1E 6DD, UK
| | - Paul Veys
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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