HLA-DR expression on monocytes and outcome of anti-CD19 CAR T-cell therapy for large B-cell lymphoma

•Low prelymphodepletion mHLA-DR correlates with older age, poorer ECOG performance status, higher tumor burden, and systemic inflammation.•Low prelymphodepletion mHLA-DR is associated with poorer duration of response and survival in LBCL treated with anti-CD19 CAR T cells. [Display omitted] Despite...

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Published in:Blood advances Vol. 7; no. 5; pp. 744 - 755
Main Authors: Bourbon, Estelle, Sesques, Pierre, Gossez, Morgane, Tordo, Jérémie, Ferrant, Emmanuelle, Safar, Violaine, Wallet, Florent, Aussedat, Guillaume, Maarek, Alizée, Bouafia, Fadhela, Karlin, Lionel, Ghergus, Dana, Golfier, Camille, Lequeu, Hélène, Lazareth, Anne, Schwiertz, Vérane, Viel, Sébastien, Idlhaj, Maryam, Ghesquières, Hervé, Monneret, Guillaume, Bachy, Emmanuel, Venet, Fabienne
Format: Journal Article
Language:English
Published: United States Elsevier Inc 14.03.2023
The American Society of Hematology
Subjects:
HLA-DR Antigens
Humans
Immunobiology and Immunotherapy
Immunotherapy, Adoptive - adverse effects
Life Sciences
Lymphoma, Large B-Cell, Diffuse - therapy
Monocytes
Neoplasm Recurrence, Local
ISSN:2473-9529, 2473-9537, 2473-9537
Online Access:Get full text
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Summary:•Low prelymphodepletion mHLA-DR correlates with older age, poorer ECOG performance status, higher tumor burden, and systemic inflammation.•Low prelymphodepletion mHLA-DR is associated with poorer duration of response and survival in LBCL treated with anti-CD19 CAR T cells. [Display omitted] Despite their unprecedented success in relapsed/refractory (R/R) large B-cell lymphoma (LBCL), anti-CD19 CAR T cells are associated with significant toxicity, and more than half of patients relapse. As monocytes emerged as key players in CAR therapy, we sought to evaluate the evolution of HLA-DR expression on monocytes (mHLA-DR) before and after commercial anti-CD19 CAR T-cell infusion in a large cohort (n = 103) of patients with R/R LBCL and its association with adverse events and treatment response. Cy-Flu-based lymphodepletion (LD) upregulated mHLA-DR in 79% of the cases, whereas in 2l% of cases (15 patients), the mHLA-DR level decreased after LD, and this decrease was associated with poorer outcome. Low mHLA-DR at day minus 7 (D−7) (<13 500 antibodies per cell) before CAR T-cell infusion correlated with older age, poorer performance status, higher tumor burden, and elevated inflammatory markers. With a median follow-up of 7.4 months, patients with low mHLA-DR D−7 exhibited a poorer duration of response and survival than the higher mHLA-DR D−7 group. For toxicity management, tocilizumab was more frequently used in the low–mHLA-DR D−7 group. These data suggest that monocyte dysregulation before LD, characterized by the downregulation of mHLA-DR, correlates with an inflammatory and immunosuppressive tumor environment and is associated with failure of anti-CD19 CAR T cells in patients with R/R LBCL. Modulation of these myeloid cells represents a promising field for improving CAR therapy.
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PMCID: PMC9989525
E. Bachy and F.B. contributed equally to this study.
E. Bourbon and P.S. contributed equally to this study.
ISSN:2473-9529
2473-9537
2473-9537
DOI:10.1182/bloodadvances.2021006563