The immune setting might decide the sturdiness of the CAR-T response to a number of myeloma.

31 August 2022

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Dhodapkar KM, et al. Blood Most cancers Discovery, 2022; doi: 10.1158/2643-3230.BCD-22-0018.

Disclosure: The Leukemia and Lymphoma Society, NIH, and the Paula and Roger Rainey Basis supported this examine. Dhodapkar experiences assist from Janssen, Lava Therapeutics and Sanofi exterior of the work introduced. Please check with the examine for the related monetary disclosures of all different authors.

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Extended responses to chimeric antigen receptor T-cell remedy for superior a number of myeloma might rely on the composition of the affected person’s post-treatment immune microenvironment, outcomes of a retrospective examine have proven.

Sufferers with extended PFS after B-cell maturation antigen (BCMA)-targeted CAR-T had the next proportion of T cells and a decrease proportion of myeloid cells within the bone marrow, which researchers from Emory College and the college achieved a shorter PFS. was. Pennsylvania decided.

madhav dhodapakri
Knowledge obtained from Dhodapkar KM, et al. Blood Most cancers Discovery, 2022; doi: 10.1158/2643-3230.BCD-22-0018.

Sufferers with extended PFS had larger CAR T cells and different immune cells, which exhibited decrease genomic ranges of cell exhaustion, than these with shorter PFS, in line with the outcomes revealed in . blood most cancers discovery in addition to introduced on the annual assembly of the Worldwide Myeloma Society.


“Two CAR T-cell Therapy Concentrating on [BCMA] has now been permitted for the therapy of [multiple] myeloma, however the problem is that many responses to this remedy should not sustainable and sufferers stay prone to recurrence.” madhav V Dhodapkar, MBBS, Professor of Emory College College of Medication and director of the Middle for Most cancers Immunology at Emory College’s Winship Most cancers Institute, stated in a press launch issued by the American Affiliation for Most cancers Analysis. “A significant objective within the discipline is to determine the components that have an effect on the sturdiness of the response in order that we will enhance therapy accordingly.”


Dhodapkar and colleagues analyzed 28 pre- and post-treatment bone marrow samples from 11 sufferers who obtained BCMA-guided CAR T cells as a part of a earlier Section 1 trial and responded to remedy.

The investigators analyzed bone marrow samples utilizing a number of single-cell strategies, together with CITE-Seq, transcriptomics, mass cytometry and T-cell receptor sequencing.

The researchers categorised the sufferers right into a “lengthy PFS” group — that means a PFS of 6 months or extra — and a “quick PFS” group, that means a PFS of 6 months or much less.

The investigators in contrast modifications in immune cell composition and bone marrow microenvironment between the quick PFS and lengthy PFS teams to find out components that correlated with extended response to remedy.

key findings

The presence of hyperexpanded clones with exhaustion phenotype, in addition to BAFF-positive/PD-L1-positive myeloid cells within the marrow, seemed to be related to shorter PFS after CAR T-cell remedy.

An elevated proportion of CLEC9A-positive dendritic cells, CD27-positive/TCF1-positive T cells with various T-cell receptors, and a rise of T cells that specific bone marrow-resident genes correlated with extended PFS.

medical implications

A number of prior research have centered on how the traits of CAR T cells have an effect on therapy sturdiness. Dhodapkar stated this examine is exclusive in that it centered on how different immune cells within the tumor microenvironment may affect responses following remedy.

“This discovery has broad implications for the CAR T-cell remedy discipline, because it emphasizes the significance of the affected person’s pre-existing immune microenvironment as a determinant of sturdy responses,” they stated within the press launch.

Dhodapkar acknowledged the examine’s limitations, together with its small pattern dimension, and famous the necessity for bigger unbiased research to substantiate his group’s findings.

“Our evaluation of responding sufferers receiving an experimental BCMA-specific CAR T-cell remedy means that sturdy responses might rely not solely on the properties of CAR T cells but in addition on the endogenous T-cell states and properties . [tumor microenvironment]together with/with myeloid[dendritic cell] compartment and the tumor cells themselves,” wrote Dhodapkar and his colleagues.

The evaluation by Dhodapkar and colleagues was “the primary to systematically study the hematopoietic cell lineages related to the length of the response of BCMA-targeted CAR T cells. [tumor microenvironment], Charlotte E. GrahamM, MRCP, FRCPath, PhD, And Marcella V. Mauss, MD, PhD, Each from the Mobile Immunotherapy Program at Harvard Medical College and Mass Common Most cancers Middle, wrote in an accompanying commentary.

Graham and Mauss wrote, “The authors present that endogenous T cells, myeloid cells and dendritic cell populations might affect or correlate with the length of the response of BCMA CAR T cells.” “This suggests that the response is just not merely a direct interplay between effector and goal cells, however it’s a favorable [tumor microenvironment] Required for sustained anti-tumor exercise.”

“Additional research are wanted to delineate the mechanisms by which endogenous bone marrow immune cells might exert an impact on BCMA CAR T cell perform,” stated Graham and Mauss.

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