T cells with chimeric antigen receptors have potent antitumor effects and can establish memory in patients with advanced leukemia
Michael Kalos, Bruce L Levine, David L Porter, Sharyn Katz, Stephan A Grupp, Adam Bagg, Carl H June, Michael Kalos, Bruce L Levine, David L Porter, Sharyn Katz, Stephan A Grupp, Adam Bagg, Carl H June
Abstract
Tumor immunotherapy with T lymphocytes, which can recognize and destroy malignant cells, has been limited by the ability to isolate and expand T cells restricted to tumor-associated antigens. Chimeric antigen receptors (CARs) composed of antibody binding domains connected to domains that activate T cells could overcome tolerance by allowing T cells to respond to cell surface antigens; however, to date, lymphocytes engineered to express CARs have demonstrated minimal in vivo expansion and antitumor effects in clinical trials. We report that CAR T cells that target CD19 and contain a costimulatory domain from CD137 and the T cell receptor ζ chain have potent non-cross-resistant clinical activity after infusion in three of three patients treated with advanced chronic lymphocytic leukemia (CLL). The engineered T cells expanded >1000-fold in vivo, trafficked to bone marrow, and continued to express functional CARs at high levels for at least 6 months. Evidence for on-target toxicity included B cell aplasia as well as decreased numbers of plasma cells and hypogammaglobulinemia. On average, each infused CAR-expressing T cell was calculated to eradicate at least 1000 CLL cells. Furthermore, a CD19-specific immune response was demonstrated in the blood and bone marrow, accompanied by complete remission, in two of three patients. Moreover, a portion of these cells persisted as memory CAR(+) T cells and retained anti-CD19 effector functionality, indicating the potential of this major histocompatibility complex-independent approach for the effective treatment of B cell malignancies.
Conflict of interest statement
Competing interests: D.L.P. and C.H.J. have filed a patent application, E61/421,470, “Composition and methods for treatment of chronic lymphocytic leukemia,” based on the CART19 cell. The other authors declare that they have no competing interests.
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Source: PubMed