同时使用双Src/ABL激酶抑制剂会消除博纳吐单抗对Ph+急性淋巴细胞白血病的体外疗效。
Concomitant use of a dual Src/ABL kinase inhibitor eliminates the in vitro efficacy of blinatumomab against Ph+ ALL.
作者信息
Leonard Jessica T, Kosaka Yoko, Malla Pavani, LaTocha Dorian, Lamble Adam, Hayes-Lattin Brandon, Byrd Kaelan, Druker Brian J, Tyner Jeffrey W, Chang Bill H, Lind Evan
机构信息
Knight Cancer Institute.
Center for Hematologic Malignancies, and.
出版信息
Blood. 2021 Feb 18;137(7):939-944. doi: 10.1182/blood.2020005655.
Blinatumomab is currently approved for use as a single agent in relapsed and refractory acute lymphoblastic leukemia (ALL). Cytotoxicity is mediated via signaling through the T-cell receptor (TCR). There is now much interest in combining blinatumomab with targeted therapies, particularly in Philadelphia chromosome-positive ALL (Ph+ ALL). However, some second- and third-generation ABL inhibitors also potently inhibit Src family kinases that are important in TCR signaling. We combined ABL inhibitors and dual Src/ABL inhibitors with blinatumomab in vitro from both healthy donor samples and primary samples from patients with Ph+ ALL. Blinatumomab alone led to both T-cell proliferation and elimination of target CD19+ cells and enhanced production of interferon-γ (IFN-γ). The addition of the ABL inhibitors imatinib or nilotinib to blinatumomab did not inhibit T-cell proliferation or IFN-γ production. However, the addition of dasatinib or ponatinib inhibited T-cell proliferation and IFN-γ production. Importantly, there was no loss of CD19+ cells treated with blinatumomab plus dasatinib or ponatinib in healthy samples or samples with a resistant ABL T315I mutation by dasatinib in combination with blinatumomab. These in vitro findings bring pause to the excitement of combination therapies, highlighting the importance of maintaining T-cell function with targeted therapies.
博纳吐单抗目前被批准作为单一药物用于复发难治性急性淋巴细胞白血病(ALL)。其细胞毒性是通过T细胞受体(TCR)信号传导介导的。目前人们对将博纳吐单抗与靶向治疗联合使用很感兴趣,尤其是在费城染色体阳性ALL(Ph+ ALL)中。然而,一些第二代和第三代ABL抑制剂也能有效抑制在TCR信号传导中起重要作用的Src家族激酶。我们在体外将ABL抑制剂和双重Src/ABL抑制剂与博纳吐单抗联合使用,样本来自健康供体以及Ph+ ALL患者的原代样本。单独使用博纳吐单抗可导致T细胞增殖、消除靶CD19+细胞并增强干扰素-γ(IFN-γ)的产生。在博纳吐单抗中添加ABL抑制剂伊马替尼或尼洛替尼不会抑制T细胞增殖或IFN-γ的产生。然而,添加达沙替尼或波纳替尼会抑制T细胞增殖和IFN-γ的产生。重要的是,在健康样本或对达沙替尼具有耐药性ABL T315I突变的样本中,用博纳吐单抗加用达沙替尼或波纳替尼处理的CD19+细胞没有损失。这些体外研究结果给联合治疗的热潮带来了思考,突出了在靶向治疗中维持T细胞功能的重要性。