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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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