[HTML][HTML] CAR T-cells that target acute B-lineage leukemia irrespective of CD19 expression

K Fousek, J Watanabe, SK Joseph, A George, X An… - Leukemia, 2021 - nature.com
K Fousek, J Watanabe, SK Joseph, A George, X An, TT Byrd, JS Morris, A Luong…
Leukemia, 2021nature.com
Chimeric antigen receptor (CAR) T-cells targeting CD19 demonstrate remarkable efficacy in
treating B-lineage acute lymphoblastic leukemia (BL-ALL), yet up to 39% of treated patients
relapse with CD19 (−) disease. We report that CD19 (−) escape is associated with
downregulation, but preservation, of targetable expression of CD20 and CD22. Accordingly,
we reasoned that broadening the spectrum of CD19CAR T-cells to include both CD20 and
CD22 would enable them to target CD19 (−) escape BL-ALL while preserving their upfront …
Abstract
Chimeric antigen receptor (CAR) T-cells targeting CD19 demonstrate remarkable efficacy in treating B-lineage acute lymphoblastic leukemia (BL-ALL), yet up to 39% of treated patients relapse with CD19(−) disease. We report that CD19(−) escape is associated with downregulation, but preservation, of targetable expression of CD20 and CD22. Accordingly, we reasoned that broadening the spectrum of CD19CAR T-cells to include both CD20 and CD22 would enable them to target CD19(−) escape BL-ALL while preserving their upfront efficacy. We created a CD19/20/22-targeting CAR T-cell by coexpressing individual CAR molecules on a single T-cell using one tricistronic transgene. CD19/20/22CAR T-cells killed CD19(−) blasts from patients who relapsed after CD19CAR T-cell therapy and CRISPR/Cas9 CD19 knockout primary BL-ALL both in vitro and in an animal model, while CD19CAR T-cells were ineffective. At the subcellular level, CD19/20/22CAR T-cells formed dense immune synapses with target cells that mediated effective cytolytic complex formation, were efficient serial killers in single-cell tracking studies, and were as efficacious as CD19CAR T-cells against primary CD19(+) disease. In conclusion, independent of CD19 expression, CD19/20/22CAR T-cells could be used as salvage or front-line CAR therapy for patients with recalcitrant disease.
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