Department of Pediatrics I, ALL-BFM Study Group, Christian-Albrecht University Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany.
OSE Immunotherapeutics, Nantes, France.
Blood. 2024 Jun 27;143(26):2735-2748. doi: 10.1182/blood.2023021088.
Acute lymphoblastic leukemia (ALL) arises from the uncontrolled proliferation of B-cell precursors (BCP-ALL) or T cells (T-ALL). Current treatment protocols obtain high cure rates in children but are based on toxic polychemotherapy. Novel therapies are urgently needed, especially in relapsed/refractory (R/R) disease, high-risk (HR) leukemias and T-ALL, in which immunotherapy approaches remain scarce. Although the interleukin-7 receptor (IL-7R) plays a pivotal role in ALL development, no IL-7R-targeting immunotherapy has yet reached clinical application in ALL. The IL-7Rα chain (CD127)-targeting IgG4 antibody lusvertikimab (LUSV; formerly OSE-127) is a full antagonist of the IL-7R pathway, showing a good safety profile in healthy volunteers. Here, we show that ∼85% of ALL cases express surface CD127. We demonstrate significant in vivo efficacy of LUSV immunotherapy in a heterogeneous cohort of BCP- and T-ALL patient-derived xenografts (PDX) in minimal residual disease (MRD) and overt leukemia models, including R/R and HR leukemias. Importantly, LUSV was particularly effective when combined with polychemotherapy in a phase 2-like PDX study with CD127high samples leading to MRD-negativity in >50% of mice treated with combination therapy. Mechanistically, LUSV targeted ALL cells via a dual mode of action comprising direct IL-7R antagonistic activity and induction of macrophage-mediated antibody-dependent cellular phagocytosis (ADCP). LUSV-mediated in vitro ADCP levels significantly correlated with CD127 expression levels and the reduction of leukemia burden upon treatment of PDX animals in vivo. Altogether, through its dual mode of action and good safety profile, LUSV may represent a novel immunotherapy option for any CD127+ ALL, particularly in combination with standard-of-care polychemotherapy.
急性淋巴细胞白血病 (ALL) 是由 B 细胞前体 (BCP-ALL) 或 T 细胞 (T-ALL) 的不受控制的增殖引起的。目前的治疗方案在儿童中获得了很高的治愈率,但基于毒性化疗。迫切需要新的治疗方法,特别是在复发/难治性 (R/R) 疾病、高危 (HR) 白血病和 T-ALL 中,其中免疫治疗方法仍然很少。尽管白细胞介素-7 受体 (IL-7R) 在 ALL 发展中起着至关重要的作用,但目前还没有针对 IL-7R 的免疫疗法在 ALL 中得到临床应用。靶向 IL-7Rα 链 (CD127) 的 IgG4 抗体 lusvertikimab (LUSV;以前称为 OSE-127) 是 IL-7R 通路的完全拮抗剂,在健康志愿者中表现出良好的安全性。在这里,我们表明约 85%的 ALL 病例表达表面 CD127。我们在 BCP 和 T-ALL 患者来源异种移植 (PDX) 的异质队列中证明了 LUSV 免疫治疗在微小残留病 (MRD) 和显性白血病模型中的显著体内疗效,包括 R/R 和 HR 白血病。重要的是,在一项类似 2 期的 PDX 研究中,当 LUSV 与化疗联合使用时,CD127high 样本的组合治疗导致 >50%的小鼠达到 MRD 阴性,LUSV 具有特别的疗效。从机制上讲,LUSV 通过直接的 IL-7R 拮抗作用和诱导巨噬细胞介导的抗体依赖性细胞吞噬作用 (ADCP) 的双重作用靶向 ALL 细胞。LUSV 介导的体外 ADCP 水平与 CD127 表达水平显著相关,并与 PDX 动物体内治疗后白血病负担的减少相关。总的来说,通过其双重作用模式和良好的安全性,LUSV 可能代表任何 CD127+ ALL 的新型免疫治疗选择,特别是与标准护理化疗联合使用时。