Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer Immunol Res. 2019 Jan;7(1):100-112. doi: 10.1158/2326-6066.CIR-18-0307. Epub 2018 Nov 5.
NKG2D ligands are widely expressed in solid and hematologic malignancies but absent or poorly expressed on healthy tissues. We conducted a phase I dose-escalation study to evaluate the safety and feasibility of a single infusion of NKG2D-chimeric antigen receptor (CAR) T cells, without lymphodepleting conditioning in subjects with acute myeloid leukemia/myelodysplastic syndrome or relapsed/refractory multiple myeloma. Autologous T cells were transfected with a γ-retroviral vector encoding a CAR fusing human NKG2D with the CD3ζ signaling domain. Four dose levels (1 × 10-3 × 10 total viable T cells) were evaluated. Twelve subjects were infused [7 acute myeloid leukemia (AML) and 5 multiple myeloma]. NKG2D-CAR products demonstrated a median 75% vector-driven NKG2D expression on CD3 T cells. No dose-limiting toxicities, cytokine release syndrome, or CAR T cell-related neurotoxicity was observed. No significant autoimmune reactions were noted, and none of the ≥ grade 3 adverse events were attributable to NKG2D-CAR T cells. At the single injection of low cell doses used in this trial, no objective tumor responses were observed. However, hematologic parameters transiently improved in one subject with AML at the highest dose, and cases of disease stability without further therapy or on subsequent treatments were noted. At 24 hours, the cytokine RANTES increased a median of 1.9-fold among all subjects and 5.8-fold among six AML patients. Consistent with preclinical studies, NKG2D-CAR T cell-expansion and persistence were limited. Manufactured NKG2D-CAR T cells exhibited functional activity against autologous tumor cells , but modifications to enhance CAR T-cell expansion and target density may be needed to boost clinical activity.
NKG2D 配体在实体瘤和血液恶性肿瘤中广泛表达,但在健康组织中缺失或表达水平较低。我们进行了一项 I 期剂量递增研究,以评估在急性髓系白血病/骨髓增生异常综合征或复发/难治性多发性骨髓瘤患者中,单次输注 NKG2D 嵌合抗原受体(CAR)T 细胞的安全性和可行性,无需进行淋巴细胞耗竭预处理。自体 T 细胞通过编码 CAR 的γ逆转录病毒载体转染,该 CAR 融合了人 NKG2D 与 CD3ζ信号结构域。评估了四个剂量水平(总活 T 细胞 1×10-3×10)。共输注了 12 名患者[7 名急性髓系白血病(AML)和 5 名多发性骨髓瘤]。NKG2D-CAR 产品在 CD3 T 细胞上显示出中位数为 75%的载体驱动的 NKG2D 表达。未观察到剂量限制毒性、细胞因子释放综合征或 CAR T 细胞相关神经毒性。未观察到明显的自身免疫反应,且≥3 级的不良事件均与 NKG2D-CAR T 细胞无关。在本试验中使用的低细胞剂量单次注射中,未观察到客观的肿瘤反应。然而,在最高剂量下,1 名 AML 患者的血液学参数短暂改善,且有疾病稳定而无需进一步治疗或后续治疗的病例。在 24 小时时,所有受试者的 RANTES 细胞因子中位数增加了 1.9 倍,6 名 AML 患者增加了 5.8 倍。与临床前研究一致,NKG2D-CAR T 细胞的扩增和持久性有限。制造的 NKG2D-CAR T 细胞对自体肿瘤细胞表现出功能活性,但可能需要对其进行修饰以增强 CAR T 细胞的扩增和靶密度,从而提高临床活性。
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