Posttransplant chimeric antigen receptor therapy

M Smith, J Zakrzewski, S James… - Blood, The Journal of …, 2018 - ashpublications.org
M Smith, J Zakrzewski, S James, M Sadelain
Blood, The Journal of the American Society of Hematology, 2018ashpublications.org
Therapeutic T-cell engineering is emerging as a powerful approach to treat refractory
hematological malignancies. Its most successful embodiment to date is based on the use of
second-generation chimeric antigen receptors (CARs) targeting CD19, a cell surface
molecule found in most B-cell leukemias and lymphomas. Remarkable complete remissions
have been obtained with autologous T cells expressing CD19 CARs in patients with
relapsed, chemo-refractory B-cell acute lymphoblastic leukemia, chronic lymphocytic …
Abstract
Therapeutic T-cell engineering is emerging as a powerful approach to treat refractory hematological malignancies. Its most successful embodiment to date is based on the use of second-generation chimeric antigen receptors (CARs) targeting CD19, a cell surface molecule found in most B-cell leukemias and lymphomas. Remarkable complete remissions have been obtained with autologous T cells expressing CD19 CARs in patients with relapsed, chemo-refractory B-cell acute lymphoblastic leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma. Allogeneic CAR T cells may also be harnessed to treat relapse after allogeneic hematopoietic stem cell transplantation. However, the use of donor T cells poses unique challenges owing to potential alloreactivity. We review different approaches to mitigate the risk of causing or aggravating graft-versus-host disease (GVHD), including CAR therapies based on donor leukocyte infusion, virus-specific T cells, T-cell receptor–deficient T cells, lymphoid progenitor cells, and regulatory T cells. Advances in CAR design, T-cell selection and gene editing are poised to enable the safe use of allogeneic CAR T cells without incurring GVHD.
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