B cell maturation antigen-specific CAR T cells are clinically active in multiple myeloma
Adam D Cohen, Alfred L Garfall, Edward A Stadtmauer, J Joseph Melenhorst, Simon F Lacey, Eric Lancaster, Dan T Vogl, Brendan M Weiss, Karen Dengel, Annemarie Nelson, Gabriela Plesa, Fang Chen, Megan M Davis, Wei-Ting Hwang, Regina M Young, Jennifer L Brogdon, Randi Isaacs, Iulian Pruteanu-Malinici, Don L Siegel, Bruce L Levine, Carl H June, Michael C Milone, Adam D Cohen, Alfred L Garfall, Edward A Stadtmauer, J Joseph Melenhorst, Simon F Lacey, Eric Lancaster, Dan T Vogl, Brendan M Weiss, Karen Dengel, Annemarie Nelson, Gabriela Plesa, Fang Chen, Megan M Davis, Wei-Ting Hwang, Regina M Young, Jennifer L Brogdon, Randi Isaacs, Iulian Pruteanu-Malinici, Don L Siegel, Bruce L Levine, Carl H June, Michael C Milone
Abstract
Background: Chimeric antigen receptor (CAR) T cells are a promising therapy for hematologic malignancies. B-cell maturation antigen (BCMA) is a rational target in multiple myeloma (MM).
Methods: We conducted a phase I study of autologous T cells lentivirally-transduced with a fully-human, BCMA-specific CAR containing CD3ζ and 4-1BB signaling domains (CART-BCMA), in subjects with relapsed/refractory MM. Twenty-five subjects were treated in 3 cohorts: 1) 1-5 x 108 CART-BCMA cells alone; 2) Cyclophosphamide (Cy) 1.5 g/m2 + 1-5 x 107 CART-BCMA cells; and 3) Cy 1.5 g/m2 + 1-5 x 108 CART-BCMA cells. No pre-specified BCMA expression level was required.
Results: CART-BCMA cells were manufactured and expanded in all subjects. Toxicities included cytokine release syndrome and neurotoxicity, which were grade 3-4 in 8 (32%) and 3 (12%) subjects, respectively, and reversible. One subject died at day 24 from candidemia and progressive myeloma, following treatment for severe CRS and encephalopathy. Responses (based on treated subjects) were seen in 4/9 (44%) in cohort 1, 1/5 (20%) in cohort 2, and 7/11 (64%) in cohort 3, including 5 partial, 5 very good partial, and 2 complete responses, 3 of which were ongoing at 11, 14, and 32 months. Decreased BCMA expression on residual MM cells was noted in responders; expression increased at progression in most. Responses and CART-BCMA expansion were associated with CD4:CD8 T cell ratio and frequency of CD45RO-CD27+CD8+ T cells in the pre-manufacturing leukapheresis product.
Conclusion: CART-BCMA infusions with or without lymphodepleting chemotherapy are clinically active in heavily-pretreated MM patients.
Trial registration: NCT02546167.
Funding: University of Pennsylvania-Novartis Alliance and NIH.
Keywords: Cancer immunotherapy; Clinical Trials; Oncology.
Conflict of interest statement
Conflict of interest: ADC reports research funding from Novartis, research funding and personal fees from Bristol-Meyers Squibb, and personal fees from Celgene, Kite Pharma, Janssen, Seattle Genetics, Oncopeptides, Takeda, Array Biopharma, and GlaxoSmithKline. ALG reports research funding from Novartis and Amgen, personal fees from Kite Pharma, and research funding and personal fees from Tmunity. EAS reports research funding from AbbVie and personal fees from Celgene, Takeda, Janssen, and Amgen. SFL reports research funding and other from Novartis and research funding from Tmunity. EL reports research funding from Grifols Inc. and personal fees from Merck Inc. and Novartis Inc. DTV reports personal fees from Karyopharm, Amgen, Millennium/Takeda, and Celgene, and research funding from GlaxoSmithKline. BMW reports research funding from Novartis, personal fees from Novartis and Alnylam, and research funding from Janssen and Prothena. BMW became an employee of Janssen Research and Development in October 2017. JJM, GP, RMY, and MCM report research funding from Novartis. JLB, RI, and IPM are employees of Novartis. DLS reports other from Poseida Therapeutics. BLL reports research funding from Novartis, personal fees from Avectas, Brammer Bio, Incysus, CRC Oncology/Cure Genetics, Novartis, Terumo, and Draper Labs, and other from Tmunity Therapeutics. CHJ reports research funding from Novartis, and he is a scientific founder of Tmunity Therapeutics, for which he has founders stock but no income. ADC, ALG, EAS, JJM, SFL, EL, GP, FC, MMD, BLL, CHJ, and MCM hold or have pending patents (15/757,123, 17/042,129, 16/050,112, 62/586,834, 62/593,043, 62/752,010, 62/588,836) related to intellectual property licensed by the University of Pennsylvania to Novartis.
Figures
![Figure 1. Treatment schema.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g001.jpg)
![Figure 2. Clinical outcomes.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g002.jpg)
![Figure 3. CART-BCMA expansion and persistence.](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g003.jpg)
![Figure 4. Serum cytokines associated with CRS…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g004.jpg)
![Figure 5. Soluble BCMA (sBCMA), BAFF, and…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g005.jpg)
![Figure 6. Predictors of in vivo CART-BCMA…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6546468/bin/jci-129-126397-g006.jpg)
Source: PubMed