Summary
As a rapidly progressing field in oncology, the adoptive transfer of T cells that have been genetically modified with chimeric antigen receptors (CARs) has shown striking efficacy in the management of hematological malignancies and has been reported in a number of clinical trials. Of note, CAR T cell therapy has shown extraordinary potential, especially in relapsed/refractory patients. However, there are still challenges regarding the further development of this strategy, spanning from engineering and manufacturing issues, to limited applications, to accompanying toxicities. In this review, we will summarize the general knowledge of this novel method, including receptor composition, applications, adverse events and challenges. Additionally, we will propose several comprehensive recommendations.
Change history
13 February 2021
An Erratum to this paper has been published: https://doi.org/10.1007/s11596-020-2280-3
References
- 1
Ritchie DS, Neeson PJ, Khot A, et al. Persistence and efficacy of second generation CAR T cell against the LeY antigen in acute myeloid leukemia. Mol Ther, 2013,21(11):2122–2129
- 2
Jackson HJ, Rafiq S, Brentjens RJ. Driving CAR T-cells forward. Nat Rev Clin Oncol, 2016,13:370–383
- 3
Fesnak AD, June CH, Levine BL. Engineered T cells: the promise and challenges of cancer immunotherapy. Nat Rev Cancer, 2016,16:566–581
- 4
Heuser C, Hombach A, Losch C, et al. T-cell activation by recombinant immunoreceptors: impact of the intracellular signalling domain on the stability of receptor expression and antigen-specific activation of grafted T cells. Gene Ther, 2003,10(17):1408–1419
- 5
Song DG, Ye Q, Poussin M, et al. CD27 costimulation augments the survival and antitumor activity of redirected human T cells in vivo. Blood, 2012,119(3):696–706
- 6
Milone MC, Fish JD, Carpenito C, et al. Chimeric receptors containing CD137 signal transduction domains mediate enhanced survival of T cells and increased antileukemic efficacy in vivo. Mol Ther, 2009,17(8):1453–1464
- 7
Till BG, Jensen MC, Wang J, et al. CD20-specific adoptive immunotherapy for lymphoma using a chimeric antigen receptor with both CD28 and 4-1BB domains: pilot clinical trial results. Blood, 2012,119(17):3940–3950
- 8
Hombach AA, Heiders J, Foppe M, et al. OX40 costimulation by a chimeric antigen receptor abrogates CD28 and IL-2 induced IL-10 secretion by redirected CD4(+) T cells. Oncormmunology, 2012,1(4):458–466
- 9
Pegram HJ, Lee JC, Hayman EG, et al. Tumor-targeted T-cells modified to secrete IL-12 eradicate systemic tumors without need for prior conditioning. Blood, 2012,119(18):4133–4141
- 10
Chmielewski M, Abken H. TRUCKs: the fourth generation of CARs. Expert Opin Biol Ther, 2015,15(8):1145–1154
- 11
Gill S, Maus MV, Porter DL. Chimeric antigen receptor T cell therapy: 25 years in the making. Blood Rev, 2016,30:157–167
- 12
Jain N, O’Brien S. Targeted therapies for CLL: practical issues with the changing treatment paradigm. Blood Rev, 2016,30:233–244
- 13
Fujiwara H. Adoptive immunotherapy for hematological malignancies using T cells gene-modified to express tumor antigen-specific receptors. Pharmaceuticals (Basel), 2014,7(12):1049–1068
- 14
Maude SL, Frey N, Shaw PA, et al. Chimeric antigen receptor T cells for sustained remissio ns in leukemia. N Engl J Med, 2014,371(16):1507–1517
- 15
Grupp SA, Laetsch TW, Buechner J, et al. Analysis of a global registration trial of the efficacy and safety of CTL019 in pediatric and young adults with relapsed/refractory acute lymphoblastic leukemia (ALL). Blood, 2016,128:221–221
- 16
Maude SL, Laetsch TW, Buechner J, et al. Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia. N Engl J Med, 2018,378(5):439–448
- 17
Mamonkin M, Rouce RH, Tashiro H, et al. A T-cell directed chimeric antigen receptor for the selective treatment of T-cell malignancies. Blood, 2015,126(8):983–992
- 18
Pinz K, Liu H, Golightly M, et al. Preclinical targeting of human T-cell malignancies using CD4-specific chimeric antigen receptor (CAR)-engineered T cells. Leukemia, 2016,30(3):701–707
- 19
Huang L, Wang N, Cao Y. CAR22/19 Cocktail Therapy for Patients with Refractory/Relapsed B-Cell Malignancies. Blood, 2018,132:(abstract1408)
- 20
Wang QS, Wang Y, Lv HY, et al. Treatment of CD33-directed chimeric antigen receptor-modified T cells in one patient with relapsed and refractory acute myeloid leukemia. Mol Ther, 2005,23(1):184–191
- 21
Tettamanti S, Biondi A, Biagi E, et al. CD123 AML targeting by chimeric antigen receptors: A novel magic bullet for AML therapeutics?. Oncoimmunology, 2014,3:e28835
- 22
Morsink LM, Walter RB, Ossenkoppele GJ. Prognostic and therapeutic role of CLEC12A in acute myeloid leukemia. Blood Rev, 2019,34:26–33
- 23
Kenderian SS, Ruella M, Shestova O, et al. CD33-specific chimeric antigen receptor T cells exhibit potent preclinical activity against human acute myeloid leukemia. Leukemia, 2015,29(8):1637–1647
- 24
Mewawalla P, Nathan S. Role of allogeneic transplantation in patients with chronic lymphocytic leukemia in the era of novel therapies: a review. Ther Adv Hematol, 2014,5(5):139–152
- 25
Porter DL, Levine BL, Kalos M, et al. Chimeric antigen receptor modified T cells in chronic lymphoid leukemia. N Engl J Med, 2011,365(8):725–733
- 26
Porter DL, Hwang WT, Frey NV, et al. Chimeric antigen receptor T cells persist and induce sustained remissions in relapsed refractory chronic lymphocytic leukemia. Sci Transl Med, 2015,7(303):303ra139
- 27
Kochenderfer JN, Dudley ME, Kassim SH, et al. Chemotherapy-refractory diffuse large B-cell lymphoma and indolent B-cell malignancies can be effectively treated with autologous T cells expressing an anti-CD19 chimeric antigen receptor. J Clin Oncol, 2015,33(6):540–549
- 28
Norelli M, Casucci M, Bonini C, et al. Clinical pharmacology of CAR-T cells: Linking cellular pharmacodynamics to pharmacokinetics and antitumor effects. Biochim Biophys Acta, 2016,1865(1):90–100
- 29
Mueller KT, Maude SL, Porter DL, et al. Cellular kinetics of CTL019 in relapsed/refractory B-cell acute lymphoblastic leukemia and chronic lymphocytic leukemia. Blood, 2017,130(21):2317–2325
- 30
Fraietta JA, Lacey SF, Orlando EJ, et al. Determinants of response and resistance to CD19 chimeric antigen receptor (CAR) T cell therapy of chronic lymphocytic leukemia. Nat Med, 2018,24(5):563–571
- 31
Neelapu SS, Locke FL, Bartlett NL, et al. Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med, 2017(26),377:2531–2544
- 32
Abramson JS, Chen YB. More on antiCD19 CAR T cells in CNS diffuse large-B-cell lymphoma. N Engl J Med, 2017,377(21):2102
- 33
Schuster SJ, Svoboda J, Chong EA, et al. Chimeric antigen receptor T cells in refractory B-cell lymphomas. N Engl J Med, 2017,377(26):2545–2554
- 34
Neelapu SS. An interim analysis of the ZUMA-1 study of KTE-C19 in refractory, aggressive non-Hodgkin lymphoma. Clin Adv Hematol Oncol, 2017,15(2):117–120
- 35
Locke FL, Neelapu SS, Bartlett NL, et al. Phase 1 results of ZUMA-1: a multicenter study of KTE-C19 anti-CD19 CAR T cell therapy in refractory aggressive lymphoma. Mol Ther, 2017,25(1):285–295
- 36
Fry TJ, Stetler-Stevenson M, Shah NN, et al. Clinical activity and persistence of anti-CD22 chimeric antigen receptor in children and young adults with relapsed/refractory acute lymphoblastic leukemia (ALL). Blood, 2015,126(23):(abstract1324)
- 37
Teo EC, Chew Y, Phipps C. A review of monoclonal antibody therapies in lymphoma. Crit Rev Oncol Hematol, 2016,97:72–84
- 38
Till BG, Jensen MC, Wang J, et al. Adoptive immunotherapy for indolent non-Hodgkin lymphoma and mantle cell lymphoma using genetically modified autologous CD20-specific T cells. Blood, 2008,112(6):2261–2271
- 39
Ramos CA, Ballard B, Zhang H, et al. Clinical and immunological responses after CD30-specific chimeric antigen receptor-redirected lymphocytes. J Clin Invest, 2017,127(9):3462–3471
- 40
Wang CM, Wu ZQ, Wang Y, et al. Autologous T cells expressing CD30 chimeric antigen receptors for relapsed or refractory hodgkin lymphoma: An open-label phase I trial. Clin Cancer Res, 2017,23(5):1156–1166
- 41
Heffner LT, Jagannath S, Zimmerman TM, et al. BT062, an antibody-drug conjugate directed against CD138, given weekly for 3 weeks in each 4 week cycle: safety and further evidence of clinical activity. Blood, 2015,120(21):4042
- 42
Ali SA, Shi V, Maric I, et al. T cells expressing an anti-B-cell maturation-antigen chimeric antigen receptor causes remission of multiple myeloma. Blood, 2016,128(13):1688–1700
- 43
Xu J, Wang Q, Xu H, et al. Anti-BCMA CAR-T cells for treatment of plasma cell dyscrasia: case report on POEMS syndrome and multiple myeloma. J Hematol Oncol, 2018,11(1):128
- 44
Garfall AL, Maus MV, Hwang WT, et al. Chimeric antigen receptor T cells against CD19 for multiple myeloma. N Engl J Med, 2015,373(11):1040–1047
- 45
Garfall AL, Stadtmauer EA, Maus MV, et al. Pilot study of anti-CD19 chimeric antigen receptor T cells (CTL019) in conjunction with salvage autologous stem cell transplantation for advanced multiple myeloma. Blood, 2016,128(22):(abstract974)
- 46
Gust J, Hay KA, Hanafi LA, et al. Endothelial activation and blood-brain barrier disruption in neurotoxicity after adoptive immunotherapy with CD19 CAR-T cells. Cancer Discov, 2017,7(12):1404–1419
- 47
Brentjens R, Yeh R, Bernal Y, et al. Treatment of chronic lymphocytic leukemia with genetically targeted autologous T cells: case report of an unforeseen adverse event in a phase I clinical trial. Mol Ther, 2010,18(4):666–668
- 48
Davila ML, Riviere I, Wang X, et al. Efficacy and toxicity management of 19–28z CAR T cell therapy in B cell acute lymphoblastic leukemia. Sci Transl Med, 2014,6(224):224ra25
- 49
Lee DW, Kochenderfer JN, Stetler-Stevenson M, et al. T cells expressing CD19 chimeric antigen receptors for acute lymphoblastic leukaemia in children and young adults: a phase 1 dose-escalation trial. Lancet, 2015,385(9967):517–528
- 50
Neelapu SS, Tummala S, Kebriaei P, et al. Chimeric antigen receptor T-cell therapy - assessment and management of toxicities. Nat Rev Clin Oncol, 2018,15(1):47–62
- 51
Buechner J, Grupp SA, Maude SL, et al. Global registration trial of efficacy and safety of CTL019 in pediatric and young adult patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL): update to the interim analysis. Haematological, 2017,102:178:(abstract S476)
- 52
Mei H, Jiang H, Wu Y, et al. Neurological toxicities and coagulation disorders in the cytokine release syndrome during CAR-T therapy. Br J Haematol, 2017,181(5):689–692
- 53
Xu XJ, Tang YM, Liao C, et al. Inflammatory cytokine measurement quickly discriminates gram-negative from gram-positive bacteremia in pediatric hematology/oncology patients with septic shock. Intensive Care Med, 2013,39(2):319–326
- 54
Ishii K, Shalabi H, Yates B, et al. Tocilizumab refractory cytokine release syndrome (CRS) triggered by chimeric antigen receptor (CAR)-transduced T cells may have distinct cytokine profiles compared to typical CRS. Blood, 2016,128(22):3358
- 55
Prudent V, Breitbart WS. Chimeric antigen receptor T-cell neuropsychiatric toxicity in acute lymphoblastic leukemia. Palliat Support Care, 2017,15(4):499–503
- 56
Wang Z, Guo Y, Han W. Current status and perspectives of chimeric antigen receptor modified T cells for cancer treatment. Protein Cell, 2017,8(12):896–925
- 57
Hu Y, Sun J, Wu Z, et al. Predominant cerebral cytokine release syndrome in CD19-directed chimeric antigen receptor-modified T cell therapy. J Hematol Oncol, 2016,9(1):70
- 58
Pehlivan KC, Duncan BB, Lee DW. CAR-T Cell Therapy for Acute Lymphoblastic Leukemia: Transforming the Treatment of Relapsed and Refractory Disease. Curr Hematol Malig Rep, 2018,13(5):396–406
- 59
Risma K, Jordan MB. Hemophagocytic lymphohistiocytosis: updates and evolving concepts. Curr Opin Pediatr, 2012,24(1):9–15
- 60
Bonifant CL, Jackson HJ, Brentjens RJ, et al. Toxicity and management in CAR T-cell therapy. Mol Ther Oncolytics, 2016,3:16011
- 61
Vairy S, Garcia JL, Teira PB, et al. CTL019 (tisagenlecleucel): CAR-T therapy for relapsed and refractory B-cell acute lymphoblastic leukemia. Drug Des Devel Ther, 2018,12:3885–3898
- 62
Dai H, Zhang W, Li X, et al. Tolerance and efficacy of autologous or donor-derived T cells expressing CD19 chimeric antigen receptors in adult B-ALL with extramedullary leukemia. Oncoimmunology, 2015,4(11):e1027469
- 63
Turtle CJ, Riddell SR, Maloney DG. CD19-Targeted chimeric antigen receptor-modified T-cell immunotherapy for B-cell malignancies. Clin Pharmacol Ther, 2016,100(3):252–258
- 64
Ninomiya S, Narala N, Huye L, et al. Tumor indoleamine 2,3-dioxygenase (IDO) inhibits CD19-CAR T cells and is downregulated by lymphodepleting drugs. Blood, 2015,125(25):3905–3916
- 65
Pegram HJ, Purdon TJ, van Leeuwen DG, et al. IL-12-secreting CD19-targeted cord blood-derived T cells for the immunotherapy of B-cell acute lymphoblastic leukemia. Leukemia, 2015,29(2):415–422
- 66
Curran KJ, Seinstra BA, Nikhamin Y, et al. Enhancing antitumor efficacy of chimeric antigen receptor T cells through constitutive CD40L expression. Mol Ther, 2015,23(4):769–778
- 67
Gardner R, Wu D, Cherian S, et al. Acquisition of a CD19 negative myeloid phenotype allows immune escape of MLL-rearranged B-ALL from CD19 CAR-T cell therapy. Blood, 2016,127(20):2406–2410
- 68
Sotillo E, Barrett DM, Black KL, et al. Convergence of acquired mutations and alternative splicing of CD19 enables resistance to CART-19 immunotherapy. Cancer Discov, 2015,5(12):1282–1295
- 69
Park J, Riviere I, Wang X, et al. Impact of disease burden on longterm outcome of 19–28z CAR modified T cells in adult patients with relapsed B-ALL. J Clin Oncol, 2016,34:(abstract7003)
- 70
Hamieh M, Dobrin A, Cabriolu A, et al. CAR T cell trogocytosis and cooperative killing regulate tumour antigen escape. Nature, 2019,568(7750):112–116
- 71
Wei G, Ding L, Wang J, et al. Advances of CD19-directed chimeric antigen receptor-modified T cells in refractory/relapsed acute lymphoblastic leukemia. Exp Hematol Oncol, 2017,6:10
- 72
Haso W, Lee DW, Shah NN, et al. Anti-CD22-chimeric antigen receptors targeting B-cell precursor acute lymphoblastic leukemia. Blood, 2013,121(7):1165–1174
- 73
Ruella M, Maus MV. Catch me if you can: leukemia escape after CD19-directed T cell immunotherapies. Comput Struct Biotechnol J, 2016,14:357–362
- 74
Dufort F, Su L, Wu L, et al. Activity of CAR19 T cells secreting impact fusion proteins against hematopoietic and solid tumors. Am Soc Clin Oncol, 2018,36(15):e15046
- 75
Cho JH, Collins JJ, Wong WW. Universal Chimeric Antigen Receptors for Multiplexed and Logical Control of T Cell Responses. Cell, 2018,173(6):1426–1438
- 76
Zhao J, Lin Q, Song Y. Universal CARs, universal T cells, and universal CAR T cells. J Hematol Oncol, 2018,11(1):132
Author information
Affiliations
Corresponding author
Additional information
Conflict of Interest Statement
The authors have declared that they have no conflicts of interest.
This project was supported by the Key Program of the National Natural Science Foundation (NNSF) of China (No. 81230052 and No. 81630006).
Rights and permissions
About this article
Cite this article
Yang, X., Wang, Gx. & Zhou, Jf. CAR T Cell Therapy for Hematological Malignancies. CURR MED SCI 39, 874–882 (2019). https://doi.org/10.1007/s11596-019-2118-z
Received:
Revised:
Published:
Issue Date:
Key words
- immune therapy
- chimeric antigen receptor T cells
- hematological malignancies