title: CD19-targeted T cells rapidly induce molecular remissions in adults with chemotherapy-refractory acute lymphoblastic leukemia.
abstract: Adults with relapsed B cell acute lymphoblastic leukemia (B-ALL) have a dismal prognosis. Only those patients able to achieve a second remission with no minimal residual disease (MRD) have a hope for long-term survival in the context of a subsequent allogeneic hematopoietic stem cell transplantation (allo-HSCT). We have treated five relapsed B-ALL subjects with autologous T cells expressing a CD19-specific CD28/CD3ζ second-generation dual-signaling chimeric antigen receptor (CAR) termed 19-28z. All patients with persistent morphological disease or MRD(+) disease upon T cell infusion demonstrated rapid tumor eradication and achieved MRD(-) complete remissions as assessed by deep sequencing polymerase chain reaction. Therapy was well tolerated, although significant cytokine elevations, specifically observed in those patients with morphologic evidence of disease at the time of treatment, required lymphotoxic steroid therapy to ameliorate cytokine-mediated toxicities. Indeed, cytokine elevations directly correlated to tumor burden at the time of CAR-modified T cell infusions. Tumor cells from one patient with relapsed disease after CAR-modified T cell therapy, who was ineligible for additional allo-HSCT or T cell therapy, exhibited persistent expression of CD19 and sensitivity to autologous 19-28z T cell-mediated cytotoxicity, which suggests potential clinical benefit of additional CAR-modified T cell infusions. These results demonstrate the marked antitumor efficacy of 19-28z CAR-modified T cells in patients with relapsed/refractory B-ALL and the reliability of this therapy to induce profound molecular remissions, forming a highly effective bridge to potentially curative therapy with subsequent allo-HSCT.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. brentjer@mskcc.org
authors.forename: Renier J
authors.initials: RJ
authors.lastname: Brentjens
authors.forename: Marco L
authors.initials: ML
authors.lastname: Davila
authors.forename: Isabelle
authors.initials: I
authors.lastname: Riviere
authors.forename: Jae
authors.initials: J
authors.lastname: Park
authors.forename: Xiuyan
authors.initials: X
authors.lastname: Wang
authors.forename: Lindsay G
authors.initials: LG
authors.lastname: Cowell
authors.forename: Shirley
authors.initials: S
authors.lastname: Bartido
authors.forename: Jolanta
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authors.lastname: Stefanski
authors.forename: Clare
authors.initials: C
authors.lastname: Taylor
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Olszewska
authors.forename: Oriana
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authors.lastname: Borquez-Ojeda
authors.forename: Jinrong
authors.initials: J
authors.lastname: Qu
authors.forename: Teresa
authors.initials: T
authors.lastname: Wasielewska
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.forename: Yvette
authors.initials: Y
authors.lastname: Bernal
authors.forename: Ivelise V
authors.initials: IV
authors.lastname: Rijo
authors.forename: Cyrus
authors.initials: C
authors.lastname: Hedvat
authors.forename: Rachel
authors.initials: R
authors.lastname: Kobos
authors.forename: Kevin
authors.initials: K
authors.lastname: Curran
authors.forename: Peter
authors.initials: P
authors.lastname: Steinherz
authors.forename: Joseph
authors.initials: J
authors.lastname: Jurcic
authors.forename: Todd
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authors.lastname: Rosenblat
authors.forename: Peter
authors.initials: P
authors.lastname: Maslak
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authors.lastname: Sadelain
mesh_terms: D000328:Adult; D000368:Aged; D018941:Antigens, CD19 / Q000378:metabolism*; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D013601:T-Lymphocytes / Q000378:metabolism* / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018941:Antigens, CD19