Efficacy and toxicity management of 19-28z CAR T cell therapy in B cell acute lymphoblastic leukemia
Marco L Davila, Isabelle Riviere, Xiuyan Wang, Shirley Bartido, Jae Park, Kevin Curran, Stephen S Chung, Jolanta Stefanski, Oriana Borquez-Ojeda, Malgorzata Olszewska, Jinrong Qu, Teresa Wasielewska, Qing He, Mitsu Fink, Himaly Shinglot, Maher Youssif, Mark Satter, Yongzeng Wang, James Hosey, Hilda Quintanilla, Elizabeth Halton, Yvette Bernal, Diana C G Bouhassira, Maria E Arcila, Mithat Gonen, Gail J Roboz, Peter Maslak, Dan Douer, Mark G Frattini, Sergio Giralt, Michel Sadelain, Renier Brentjens, Marco L Davila, Isabelle Riviere, Xiuyan Wang, Shirley Bartido, Jae Park, Kevin Curran, Stephen S Chung, Jolanta Stefanski, Oriana Borquez-Ojeda, Malgorzata Olszewska, Jinrong Qu, Teresa Wasielewska, Qing He, Mitsu Fink, Himaly Shinglot, Maher Youssif, Mark Satter, Yongzeng Wang, James Hosey, Hilda Quintanilla, Elizabeth Halton, Yvette Bernal, Diana C G Bouhassira, Maria E Arcila, Mithat Gonen, Gail J Roboz, Peter Maslak, Dan Douer, Mark G Frattini, Sergio Giralt, Michel Sadelain, Renier Brentjens
Abstract
We report on 16 patients with relapsed or refractory B cell acute lymphoblastic leukemia (B-ALL) that we treated with autologous T cells expressing the 19-28z chimeric antigen receptor (CAR) specific to the CD19 antigen. The overall complete response rate was 88%, which allowed us to transition most of these patients to a standard-of-care allogeneic hematopoietic stem cell transplant (allo-SCT). This therapy was as effective in high-risk patients with Philadelphia chromosome-positive (Ph(+)) disease as in those with relapsed disease after previous allo-SCT. Through systematic analysis of clinical data and serum cytokine levels over the first 21 days after T cell infusion, we have defined diagnostic criteria for a severe cytokine release syndrome (sCRS), with the goal of better identifying the subset of patients who will likely require therapeutic intervention with corticosteroids or interleukin-6 receptor blockade to curb the sCRS. Additionally, we found that serum C-reactive protein, a readily available laboratory study, can serve as a reliable indicator for the severity of the CRS. Together, our data provide strong support for conducting a multicenter phase 2 study to further evaluate 19-28z CAR T cells in B-ALL and a road map for patient management at centers now contemplating the use of CAR T cell therapy.
Conflict of interest statement
Competing interests: M. Sadelain and R.B. are co-holders of U.S. Patent 7,446,190, which covers the 19-28z receptor and was licensed to Juno Therapeutics in November 2013. M. Sadelain, R.B., and I.R. are co-founders of Juno Therapeutics. The other authors declare no competing interests.
Figures
Source: PubMed