Resistance of Hematological Malignancies to CAR T Cell Therapy

A special issue of Cells (ISSN 2073-4409).

Deadline for manuscript submissions: 30 September 2024 | Viewed by 1090

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Guest Editor
Department of Life Sciences, Los Angeles City College, Los Angeles, CA, USA
Interests: immunotherapy; NHL; ALL; apoptosis; signal transduction; adoptive cell therapy; resistance
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Special Issue Information

Dear Colleagues,

Remarkable clinical responses have been observed in patients with hematological malignancies such as non-Hodgkin’s lymphoma (NHL), Acute Lymphoblastic Leukemia (ALL), and Multiple Myeloma (MM) using modern immune-based approaches such as CD19CAR redirected adoptive T cell therapy (CAR T cell). Chimeric antigen receptors (CARs) bestow autologous T cells with antigen-specific recognition of tumor cells, activation, and proliferation independent of the major histocompatibility complex. Engineered T cell therapy (CAR and T cell receptor (TCR) engineered T lymphocytes) has shown increasing promise in clinical investigations at multiple institutions across the nation and abroad. Considerable effort has been dedicated to effector cell production (e.g., high transduction rates) and the intensity of the conditioning regimen; much less attention has been paid to the tumor and its microenvironment. It is well-established that cytotoxic T cells kill tumor targets via non-receptor (perforin/granzyme) and receptor-mediated (TNFa/TNF-R1, TNF-R2, TRAIL/TRAIL receptors (DR4, DR5, DcR1, DcR2), and Fas (CD95)/FasL (CD95L)) apoptotic signal transduction pathways. In turn, tumors may have inherent/preexisting resistance to apoptotic death signals through a variety of mechanisms. Alternatively, tumors may develop resistance to engineered T cells upon successful initial therapy, resulting in tumor recurrence or relapse.  This is due to altered dynamics of the expression profile of pro- and anti-apoptotic proteins (due to deregulation/constitutive hyper-activation of various signal transduction pathways such as NF-kB, JAK/STAT, MAPK, AKT/ PKB, etc.) favoring an anti-apoptotic tumor milieu.

Although very effective, innovative strategies are needed to improve CD19CAR T cell therapy, both in responding patients and in instances where tumors may have varying degrees of preexisting or acquired resistance to T cell-delivered apoptotic death signals. Understanding these mechanisms and obtaining strategies to render tumor cells more receptive to T cell killing could result in better response rates, reducing the intensity of the conditioning regimen or even the number of infused CAR T cells needed. This Special Issue focuses on the inherent or acquired resistance mechanisms of tumor cells which render them unresponsive to tumor-specific and highly effective CAR T cells and the design of novel strategies to render tumors sensitive to apoptotic death signals delivered by CAR T cells, thus creating a proapoptotic tumor microenvironment (immune-sensitization).

Dr. Ali R. Jazirehi
Guest Editor

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Keywords

  • NHL
  • ALL
  • CAR T cell
  • immunotherapy
  • resistance
  • apoptosis

Published Papers (1 paper)

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Review

23 pages, 1888 KiB  
Review
Immunotherapy of Hematological Malignancies of Human B-Cell Origin with CD19 CAR T Lymphocytes
by Darya Khvorost, Brittany Kendall and Ali R. Jazirehi
Cells 2024, 13(8), 662; https://doi.org/10.3390/cells13080662 - 09 Apr 2024
Viewed by 949
Abstract
Acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma (NHL) are hematological malignancies with high incidence rates that respond relatively well to conventional therapies. However, a major issue is the clinical emergence of patients with relapsed or refractory (r/r) NHL or ALL. In such circumstances, [...] Read more.
Acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma (NHL) are hematological malignancies with high incidence rates that respond relatively well to conventional therapies. However, a major issue is the clinical emergence of patients with relapsed or refractory (r/r) NHL or ALL. In such circumstances, opportunities for complete remission significantly decline and mortality rates increase. The recent FDA approval of multiple cell-based therapies, Kymriah (tisagenlecleucel), Yescarta (axicabtagene ciloleucel), Tecartus (Brexucabtagene autoleucel KTE-X19), and Breyanzi (Lisocabtagene Maraleucel), has provided hope for those with r/r NHL and ALL. These new cell-based immunotherapies use genetically engineered chimeric antigen receptor (CAR) T-cells, whose success can be attributed to CAR’s high specificity in recognizing B-cell-specific CD19 surface markers present on various B-cell malignancies and the subsequent initiation of anti-tumor activity. The efficacy of these treatments has led to promising results in many clinical trials, but relapses and adverse reactions such as cytokine release syndrome (CRS) and neurotoxicity (NT) remain pervasive, leaving areas for improvement in current and subsequent trials. In this review, we highlight the current information on traditional treatments of NHL and ALL, the design and manufacturing of various generations of CAR T-cells, the FDA approval of Kymriah, Yescarta Tecartus, and Breyanzi, and a summary of prominent clinical trials and the notable disadvantages of treatments. We further discuss approaches to potentially enhance CAR T-cell therapy for these malignancies, such as the inclusion of a suicide gene and use of FDA-approved drugs. Full article
(This article belongs to the Special Issue Resistance of Hematological Malignancies to CAR T Cell Therapy)
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