Shallis Rory M, Terry Christopher M, Lim Seah H
Division of Hematology and Oncology, Rhode Island Hospital/Brown University Warren Alpert Medical School, Room 140, APC Building, 593 Eddy Street, Providence, RI, 02903, USA.
Cancer Immunol Immunother. 2017 Jun;66(6):697-703. doi: 10.1007/s00262-017-1990-2. Epub 2017 Mar 24.
CD38, an adenine dinucleotide phosphate (ADP) ribose cyclase and a cyclic ADP ribose hydrolase, is widely expressed on the surface of multiple myeloma (MM) cells. It is known to play a pivotal role in the downstream pathways that mediate MM cell growth, signal transduction, and adhesion. The clinical use of CD38 monoclonal antibodies (MoAbs), such as daratumumab, either as monotherapy or in combination with other anti-MM agents, has produced impressive results in patients who have failed standard MM therapy. CD38 MoAbs exhibit several cytotoxic mechanisms on MM cells. In addition to the classical effector mechanisms associated with antibody therapy, CD38 MoAbs induce MM apoptosis and clonal T-cell expansion. Here, we summarize the results of some pivotal clinical studies using a human CD38 MoAb, daratumumab, in patients with MM, discuss the anti-MM effector mechanisms induced by CD38 MoAbs, and review the potential tumor antigens that may be suitable targets for immunotherapy of MM. Finally, we present a paradigm of immunotherapy for MM patients using CD38 MoAbs followed by GM-CSF and an immune checkpoint inhibitor in patients who have undergone high dose chemotherapy and autologous stem cell transplant. CD38 MoAbs have emerged as a novel and ultimately very promising immunotherapeutic agent for MM because of its ability to induce MM cytotoxicity through both arms of the adaptive immune responses.
CD38是一种磷酸二腺苷(ADP)核糖环化酶和环ADP核糖水解酶,在多发性骨髓瘤(MM)细胞表面广泛表达。已知它在介导MM细胞生长、信号转导和黏附的下游通路中起关键作用。CD38单克隆抗体(MoAbs),如达雷妥尤单抗,无论是作为单一疗法还是与其他抗MM药物联合使用,在标准MM治疗失败的患者中都取得了令人瞩目的效果。CD38 MoAbs对MM细胞表现出多种细胞毒性机制。除了与抗体治疗相关的经典效应机制外,CD38 MoAbs还可诱导MM细胞凋亡和克隆性T细胞扩增。在此,我们总结了使用人CD38 MoAb达雷妥尤单抗治疗MM患者的一些关键临床研究结果,讨论了CD38 MoAbs诱导的抗MM效应机制,并综述了可能适合MM免疫治疗的潜在肿瘤抗原。最后,我们提出了一种针对MM患者的免疫治疗模式,即在接受高剂量化疗和自体干细胞移植的患者中,先使用CD38 MoAbs,然后使用粒细胞-巨噬细胞集落刺激因子(GM-CSF)和免疫检查点抑制剂。由于CD38 MoAbs能够通过适应性免疫反应的两条途径诱导MM细胞毒性,它已成为一种新型且极具前景的MM免疫治疗药物。