Generation and infusion of multi-antigen-specific T cells to prevent complications early after T-cell depleted allogeneic stem cell transplantation-a phase I/II study

Leukemia. 2020 Mar;34(3):831-844. doi: 10.1038/s41375-019-0600-z. Epub 2019 Oct 17.

Abstract

Prophylactic infusion of selected donor T cells can be an effective method to restore specific immunity after T-cell-depleted allogeneic stem cell transplantation (TCD-alloSCT). In this phase I/II study, we aimed to reduce the risk of viral complications and disease relapses by administrating donor-derived CD8pos T cells directed against cytomegalovirus (CMV), Epstein-Barr virus (EBV) and adenovirus antigens, tumor-associated antigens (TAA) and minor histocompatibility antigens (MiHA). Twenty-seven of thirty-six screened HLA-A*02:01pos patients and their CMVpos and/or EBVpos donors were included. Using MHC-I-Streptamers, 27 T-cell products were generated containing a median of 5.2 × 106 cells. Twenty-four products were administered without infusion-related complications at a median of 58 days post alloSCT. No patients developed graft-versus-host disease during follow-up. Five patients showed disease progression without coinciding expansion of TAA/MiHA-specific T cells. Eight patients experienced CMV- and/or EBV-reactivations. Four of these reactivations were clinically relevant requiring antiviral treatment, of which two progressed to viral disease. All resolved ultimately. In 2/4 patients with EBV-reactivations and 6/8 patients with CMV-reactivations, viral loads were followed by the expansion of donor-derived virus target-antigen-specific T cells. In conclusion, generation of multi-antigen-specific T-cell products was feasible, infusions were well tolerated and expansion of target-antigen-specific T cells coinciding viral reactivations was illustrated in the majority of patients.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoviridae Infections / prevention & control
  • Adult
  • Aged
  • Antigens, Neoplasm / immunology
  • CD8-Positive T-Lymphocytes / cytology
  • Cytomegalovirus Infections / prevention & control
  • Epstein-Barr Virus Infections / prevention & control
  • Feasibility Studies
  • Female
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / therapy*
  • Humans
  • Immunotherapy
  • Male
  • Middle Aged
  • Minor Histocompatibility Antigens / immunology
  • Patient Safety
  • Stem Cell Transplantation*
  • T-Lymphocytes / immunology*
  • Transplantation, Homologous

Substances

  • Antigens, Neoplasm
  • Minor Histocompatibility Antigens