Safety and tolerability of conditioning chemotherapy followed by CD19-targeted CAR T cells for relapsed/refractory CLL
Mark B Geyer, Isabelle Rivière, Brigitte Sénéchal, Xiuyan Wang, Yongzeng Wang, Terence J Purdon, Meier Hsu, Sean M Devlin, M Lia Palomba, Elizabeth Halton, Yvette Bernal, Dayenne G van Leeuwen, Michel Sadelain, Jae H Park, Renier J Brentjens, Mark B Geyer, Isabelle Rivière, Brigitte Sénéchal, Xiuyan Wang, Yongzeng Wang, Terence J Purdon, Meier Hsu, Sean M Devlin, M Lia Palomba, Elizabeth Halton, Yvette Bernal, Dayenne G van Leeuwen, Michel Sadelain, Jae H Park, Renier J Brentjens
Abstract
Background: Subgroups of patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL) exhibit suboptimal outcomes after standard therapies, including oral kinase inhibitors. We and others have previously reported on safety and efficacy of autologous CD19-targeted CAR T-cells for these patients; here we report safety and long-term follow-up of CAR T-cell therapy with or without conditioning chemotherapy for patients with R/R CLL and indolent B-cell non-Hodgkin lymphoma (B-NHL).
Methods: We conducted a phase 1 clinical trial investigating CD19-targeted CAR T-cells incorporating a CD28 costimulatory domain (19-28z). Seventeen of 20 patients received conditioning chemotherapy prior to CAR T-cell infusion. Five patients with CLL received ibrutinib at the time of autologous T-cell collection and/or CAR T-cell administration.
Results: This analysis included 16 patients with R/R CLL and 4 patients with R/R indolent B-NHL. Cytokine release syndrome (CRS) was observed in all 20 patients but grades 3 and 4 CRS and neurological events were uncommon (10% for each). Ex vivo expansion of T-cells and proportions of CD4+/CD8+ CAR T-cells with CD62L+CD127+ immunophenotype were significantly greater in patients on ibrutinib at leukapheresis. Three of 12 evaluable CLL patients receiving conditioning chemotherapy achieved CR (two had minimal residual disease-negative CR). All patients achieving CR remained progression-free at median follow-up of 53 months.
Conclusion: Conditioning chemotherapy and 19-28z CAR T-cells were acceptably tolerated across investigated dose levels in heavily pretreated patients with R/R CLL and indolent B-NHL, and a subgroup of patients achieved durable CR. Ibrutinib therapy may modulate autologous T-cell phenotype.
Trial registration: ClinicalTrials.gov NCT00466531.
Funding: Juno Therapeutics.
Keywords: Cancer immunotherapy; Clinical Trials; Immunology; Leukemias.
Conflict of interest statement
Conflict of interest: MBG has received an honorarium from DAVA Oncology. JHP has consulted and played an advisory role for Amgen and Juno Therapeutics and has received research funding from Juno Therapeutics and Genentech/Roche. IR and RJB have consulted and played an advisory role for, have a royalty sharing agreement with, have research funding from, and own stock in Juno Therapeutics. MS has consulted and played an advisory role for, has a royalty sharing agreement with, and owns stock in Juno Therapeutics.
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Source: PubMed