决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Anti-myeloma efficacy of CAR-iNKT is enhanced with a long-acting IL-7, rhIL-7-hyFc.
这些数据提示,BCMA CAR-iNKT 可能是较 BCMA CAR-T 更安全、有效的替代选择,且 rhIL-7-hyFc 可进一步增强 BCMA CAR-iNKT 的疗效。
多发性骨髓瘤(MM)是成熟浆细胞恶性肿瘤,目前仍无法治愈。B细胞成熟抗原(BCMA)是CAR治疗的主要蛋白靶点,因为多数MM细胞高表达BCMA,而其他细胞表达有限,因此具有较有利的靶向肿瘤而较少伤及非肿瘤组织的特征。自体BCMA CAR-T治疗应答率较高,但不能治愈,并伴有细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征风险。异体CAR-T细胞具有更好的细胞适能且可缩短治疗等待时间,可能改善患者结局;但为避免移植物抗宿主病(GVHD),异体BCMA CAR-T需要基因删除T细胞受体(TCR),可能造成预料之外的功能或表型变化。恒定型自然杀伤T细胞(iNKT)具有不会引发GVHD的恒定TCR,因此可用于异体治疗而不需编辑TCR基因。本研究在骨髓瘤异种移植小鼠模型中证实BCMA CAR-iNKT具有显著抗骨髓瘤活性。长效白细胞介素7(IL-7)rhIL-7-hyFc可显著延长接受BCMA CAR-iNKT小鼠的生存期,并在初次治疗和再挑战时降低肿瘤负荷。此外,在CRS体外检测中,CAR-iNKT诱导的IL-6低于CAR-T,提示其在患者中引发CRS的可能性较低。这些结果提示,BCMA CAR-iNKT可能是更安全有效的CAR-T替代方案,且rhIL-7-hyFc可进一步增强其疗效。
Multiple myeloma (MM), a malignancy of mature plasma cells, remains incurable. B-cell maturation antigen (BCMA) is the lead protein target for chimeric antigen receptor (CAR) therapy because of its high expression in most MM, with limited expression in other cell types, resulting in favorable on-target, off tumor toxicity. The response rate to autologous BCMA CAR-T therapy is high; however, it is not curative and is associated with risks of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. Outcomes in patients treated with BCMA CAR-T cells (CAR-Ts) may improve with allogeneic CAR T-cell therapy, which offer higher cell fitness and reduced time to treatment. However, to prevent the risk of graft-versus-host disease (GVHD), allogenic BCMA CAR-Ts require genetic deletion of the T-cell receptor (TCR), which has potential for unexpected functional or phenotype changes. Invariant natural killer T cells (iNKTs) have an invariant TCR that does not cause GVHD and, as a result, can be used in an allogeneic setting without the need for TCR gene editing. We demonstrate significant anti-myeloma activity of BCMA CAR-iNKTs in a xenograft mouse model of myeloma. We found that a long-acting interleukin-7 (IL-7), rhIL-7-hyFc, significantly prolonged survival and reduced tumor burden in BCMA CAR-iNKT-treated mice in both primary and re-challenge settings. Furthermore, in CRS in vitro assays, CAR-iNKTs induced less IL-6 than CAR-Ts, suggesting a reduced likelihood of CAR-iNKT therapy to induce CRS in patients. These data suggest that BCMA CAR-iNKTs are potentially a safer, effective alternative to BCMA CAR-Ts and that BCMA CAR-iNKT efficacy is further potentiated with rhIL-7-hyFc.
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