Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Department of Medicine, University of Minnesota, Minneapolis, MN.
Blood. 2022 Feb 24;139(8):1177-1183. doi: 10.1182/blood.2021011532.
Natural killer (NK) cells are a promising alternative to T cells for cancer immunotherapy. Adoptive therapies with allogeneic, cytokine-activated NK cells are being investigated in clinical trials. However, the optimal cytokine support after adoptive transfer to promote NK cell expansion, and persistence remains unclear. Correlative studies from 2 independent clinical trial cohorts treated with major histocompatibility complex-haploidentical NK cell therapy for relapsed/refractory acute myeloid leukemia revealed that cytokine support by systemic interleukin-15 (IL-15; N-803) resulted in reduced clinical activity, compared with IL-2. We hypothesized that the mechanism responsible was IL-15/N-803 promoting recipient CD8 T-cell activation that in turn accelerated donor NK cell rejection. This idea was supported by increased proliferating CD8+ T-cell numbers in patients treated with IL-15/N-803, compared with IL-2. Moreover, mixed lymphocyte reactions showed that IL-15/N-803 enhanced responder CD8 T-cell activation and proliferation, compared with IL-2 alone. Additionally, IL-15/N-803 accelerated the ability of responding T cells to kill stimulator-derived memory-like NK cells, demonstrating that additional IL-15 can hasten donor NK cell elimination. Thus, systemic IL-15 used to support allogeneic cell therapy may paradoxically limit their therapeutic window of opportunity and clinical activity. This study indicates that stimulating patient CD8 T-cell allo-rejection responses may critically limit allogeneic cellular therapy supported with IL-15. This trial was registered at www.clinicaltrials.gov as #NCT03050216 and #NCT01898793.
自然杀伤 (NK) 细胞是癌症免疫疗法中 T 细胞的有前途的替代品。同种异体、细胞因子激活的 NK 细胞过继疗法正在临床试验中进行研究。然而,在过继转移后促进 NK 细胞扩增和持久性的最佳细胞因子支持仍不清楚。来自接受主要组织相容性复合体单倍体不相容 NK 细胞治疗复发性/难治性急性髓系白血病的 2 个独立临床试验队列的相关研究表明,与 IL-2 相比,全身白细胞介素 15 (IL-15; N-803) 的细胞因子支持导致临床活性降低。我们假设负责的机制是 IL-15/N-803 促进受体 CD8 T 细胞激活,从而加速供体 NK 细胞排斥。这一想法得到了以下支持:与 IL-2 相比,接受 IL-15/N-803 治疗的患者中增殖的 CD8+T 细胞数量增加。此外,混合淋巴细胞反应表明,与单独使用 IL-2 相比,IL-15/N-803 增强了反应性 CD8 T 细胞的激活和增殖。此外,IL-15/N-803 加速了反应性 T 细胞杀死刺激源记忆样 NK 细胞的能力,表明额外的 IL-15 可以加速供体 NK 细胞的消除。因此,用于支持同种异体细胞疗法的全身性 IL-15 可能会产生矛盾,限制其治疗机会窗口和临床活性。这项研究表明,刺激患者 CD8 T 细胞同种异体排斥反应可能会严重限制支持 IL-15 的同种异体细胞疗法。这项试验在 www.clinicaltrials.gov 上注册为 #NCT03050216 和 #NCT01898793。
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