Daratumumab depletes CD38+ immune regulatory cells, promotes T-cell expansion, and skews T-cell repertoire in multiple myeloma

J Krejcik, T Casneuf, IS Nijhof, B Verbist… - Blood, The Journal …, 2016 - ashpublications.org
J Krejcik, T Casneuf, IS Nijhof, B Verbist, J Bald, T Plesner, K Syed, K Liu…
Blood, The Journal of the American Society of Hematology, 2016ashpublications.org
Daratumumab targets CD38-expressing myeloma cells through a variety of immune-
mediated mechanisms (complement-dependent cytotoxicity, antibody-dependent cell-
mediated cytotoxicity, and antibody-dependent cellular phagocytosis) and direct apoptosis
with crosslinking. These mechanisms may also target nonplasma cells that express CD38,
which prompted evaluation of daratumumab's effects on CD38-positive immune
subpopulations. Peripheral blood (PB) and bone marrow (BM) from patients with …
Abstract
Daratumumab targets CD38-expressing myeloma cells through a variety of immune-mediated mechanisms (complement-dependent cytotoxicity, antibody-dependent cell-mediated cytotoxicity, and antibody-dependent cellular phagocytosis) and direct apoptosis with crosslinking. These mechanisms may also target nonplasma cells that express CD38, which prompted evaluation of daratumumab’s effects on CD38-positive immune subpopulations. Peripheral blood (PB) and bone marrow (BM) from patients with relapsed/refractory myeloma from 2 daratumumab monotherapy studies were analyzed before and during therapy and at relapse. Regulatory B cells and myeloid-derived suppressor cells, previously shown to express CD38, were evaluated for immunosuppressive activity and daratumumab sensitivity in the myeloma setting. A novel subpopulation of regulatory T cells (Tregs) expressing CD38 was identified. These Tregs were more immunosuppressive in vitro than CD38-negative Tregs and were reduced in daratumumab-treated patients. In parallel, daratumumab induced robust increases in helper and cytotoxic T-cell absolute counts. In PB and BM, daratumumab induced significant increases in CD8+:CD4+ and CD8+:Treg ratios, and increased memory T cells while decreasing naïve T cells. The majority of patients demonstrated these broad T-cell changes, although patients with a partial response or better showed greater maximum effector and helper T-cell increases, elevated antiviral and alloreactive functional responses, and significantly greater increases in T-cell clonality as measured by T-cell receptor (TCR) sequencing. Increased TCR clonality positively correlated with increased CD8+ PB T-cell counts. Depletion of CD38+ immunosuppressive cells, which is associated with an increase in T-helper cells, cytotoxic T cells, T-cell functional response, and TCR clonality, represents possible additional mechanisms of action for daratumumab and deserves further exploration.
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