The Preclinical Development and Clinical Monitoring Facility of the Experimental Transplantation and Immunology Branch supports the development and implementation of new protocols involving ex vivo expanded adoptive cell therapies through a core staff member working with Cell Processing in the Department of Transfusion Medicine and through support of archiving and analysis of patient blood and tissues during clinical trials. Our support for new adoptive cell therapies has included scaling up research laboratory products into clinical size expansion cultures using GMP materials and practices, preparing Standard Operating Protocols for generation of cultures, developing release criteria for products and providing documentation of these procedures for clinical IND. Following initation of each trial, we have characterized the transfered cell product and the subsequent changes in circulating patient lymphocytes. Three novel protocols involving adoptive transfer of expanded donor-derived T cells have been implemented in recent years as a result of this process. In 04-C-0055 Arm 4A, Daniel Fowler has previously utilized expanded donor-derived CD4 helper cells grown for 12 days in IL-4 and rapamycin (T.Rapa.12) to enhance donor engraftment and reduce GVHD. The Preclinical Service has supported implementation of clinical trial Arm 4B utilizing a shorter expansion period to generate cells after only 6 days of expansion (T.Rapa.6), to produce a population with increased anti-tumor potency. This product has been used this past year in an additional trial arm (Arm 4C) that combined the the T.Rapa.6 product with an altered schedule of post transplant rapamycin. Following completion of each trial arm, we have characterized the early immune reconstitution following infusion of the T.Rapa product and have assessed the T cell receptor repertoire diversity of the infused T.Rapa cells and the tranplant recipients at day 60 through spectratyping. These studies have been reported in 2013(Fowler et al, Blood, 2013). The second novel product involves expansion of autologous T cells (both CD4 and CD8) in the presence of IFNalpha and rapamycin (T1.rapa), to generate a cell product that potentially has activity against residual myeloma plasma cells. In protocol 11-C-0016 (P.I. Claude Sportes), patients with multiple myeloma undergo an autologous transplant followed by infusion of T1.Rapa cells. Clinical production of these cells was developed through our staff in Cell Processing. Following initiation of this trial, we have monitored serial changes in lymphocyte populations in blood and in bone marrow. Finally, we have supported the implementation of the first trial of the use of donor-derived anti-CD19 Chimeric Antigen Receptor (CAR)T cells in patients with relapsed or persistent lymphoma following allogenic transplant (Protocol 10-C-0052, P.I. James Kochenderfer). We have tracked the presence of CAR T cells following adoptive transfer and have characterized expression of markers of activation and anergy. These studies have demonstrated the expansion of anti-CD19 CAR T cells in the blood concurrent with the period of anti-tumor activity approximately one week after adoptive transfer (J. Kochenderfer, submitted). We have also supported the preclinical development of the TDL (tumor infiltrating donor derived lymphocyte) clinical protocol (P.I. Michael Bishop;07-C-0064), a protocol that has now closed to further accrual with Dr. Bishop's departure from NIH.(Results reported in Hardy et al, Blood, 2012). Dr. Bishop hypothesized that the donor-derived T cells found in tumor sites after alloHSCT would be enriched for effector cells that were tumor-specific in their homing and antigen specificity. He proposed that activation and ex vivo expansion of these cells through CD3/CD28 costimulation might yield a more effective form of cell therapy after alloHSCT, with enhanced anti-tumor effects and less GVHD. The PCS staff supported this project by assessing the feasibility of expanding TDL in cultures through the use of anti CD3/CD28 beads, generating a donor T cell product with high viability, very low residual B cell content, free of endotoxin or contamination;In this process, we developed methods for viably dissociating cells and culturing them under good manufacturing process (GMP) standards. We further supported the clinical approval process by developing the necessary documentation of standard operating procedures and certificates of analysis for product release, assembling GMP reagents lists, and providing links to established investigational new drug (IND) protocols for manufacture of an clinical product suitable for infusion into patients. We supported a clinical initiative to make this therapy available to a broader patient population. We have successfully expanded replicate cultures from patient marrow collected following allogeneic transplant, demonstrating significant expansion of donor-derived T cells that meet criteria for T cell numbers and viability, donor chimerism, removal of tumor cells and microbial standards;this work supported the amendment permitting expansion of the protocol to generation of TDL from bone marrow. Two patients with hematologic malignancies that are mainly localized in bone marrow were able to be treated with TDL grown from patient marrow collected under this protocol. We have also supported the clinical implementation and assessment of this protocol. We have assessed T cell expansion and clearance of B cell lymphoma and Hodgkins disease populations in the lymph node derived TDL expansion cultures in eight patients and in the bone marrow derived TDL from an additional two patients. As part of this trial, we evaluated changes in the peripheral blood following infusion of the TDL product and have been preserving aspirates of tumor sites after TDL therapy to assess molecular changes indicative of donor anti lymphoma activity. We have characterized the TDL product from both preclinical test cultures and from the first clinical trial cultures, using multiparameter flow cytometry and cytokine production assays. We have demonstrated that the TDL expansion cultures in the clinical trial resulted in a marked decline in the frequency of regulatory T cells found in the original tumor population. The final product contained more than 90% T cells, primarily T-Bet+ Th1/Tc1 cells, that had elevated expression of effector molecules including CD40L, NKG2D, and perforin, and produced primarily IFN-gamma on stimulation. These assays have been used to optimize the TDL product in terms of numerical, anti-tumor activity and persistence in vivo after re-infusion. We have shortened the culture period and investigated alterations in the cytokine milieu of the culture to enhance retention of activated CD8 effectors. These flow cytometric and molecular monitoring studies have been extended to the first of additional planned trials of immune therapies for relapse. In this trial (09-C-0224, P.I.: Nancy Hardy) donor lymphocyte infusions (a standard method of immune therapy) are infused following irradiation of selected tumor sites. Monitoring focuses on whether the irradiation and subsequent localized deaths of tumor cells has produced activation and trafficking of antigen presenting cells into the tumor and increased anti-tumor immune activation.
|Carpenter, Robert O; Evbuomwan, Moses O; Pittaluga, Stefania et al. (2013) B-cell maturation antigen is a promising target for adoptive T-cell therapy of multiple myeloma. Clin Cancer Res 19:2048-60|
|Fowler, Daniel H; Mossoba, Miriam E; Steinberg, Seth M et al. (2013) Phase 2 clinical trial of rapamycin-resistant donor CD4+ Th2/Th1 (T-Rapa) cells after low-intensity allogeneic hematopoietic cell transplantation. Blood 121:2864-74|