JP2020512983A - 最適化された多機能性t細胞を含むキメラ受容体t細胞を使用する治療 - Google Patents
最適化された多機能性t細胞を含むキメラ受容体t細胞を使用する治療 Download PDFInfo
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Abstract
Description
本出願は、2017年4月3日付で出願された米国仮特許出願第62/481,003号の利益を主張し、その開示全体が引用することにより本明細書の一部をなす。
本出願は、ASCIIフォーマットで電子的に提出された配列表を含み、その全体が引用することにより本明細書の一部をなす。2018年4月3日付けで作製された上記ASCIIコピーの名前はKPI−019WO_ST25.txtであり、564バイトのサイズである。
本発明がより容易に理解されるように、まず特定の用語を以下に定義する。以下の用語及び他の用語に対する更なる定義は、本明細書を通して記載される。
多機能性強度インデックス(PSI)は、サイトカイン強度及び多機能性細胞のパーセンテージを盛り込むことによる多機能性の尺度である(図13)。幾つかの実施形態においては、多機能性強度インデックス(PSI)は、主要カテゴリー:恒常性/増殖性、炎症性、走化性、制御性、及び免疫エフェクターにわたる32種の主要な免疫学的に関連する分子の事前に指定されたパネルにおよぶ多機能性の尺度である。幾つかの実施形態においては、サイトカイン強度は、ELISAによって測定され得る(図14)。
キメラ抗原受容体(CAR又はCAR−T)は、遺伝子操作された受容体である。これらの操作された受容体は、当該技術分野で知られている技術によりT細胞を含む免疫細胞に容易に挿入され得て、その細胞によって発現され得る。CARにより、単一の受容体は、特異抗原を認識するとともに、その抗原に結合した場合に免疫細胞を活性化させてその抗原を持っている細胞を攻撃して破壊するよう、プログラム化され得る。これらの抗原が腫瘍細胞上に存在する場合、CARを発現する免疫細胞は、腫瘍細胞を標的とし、死滅させることができる。キメラ抗原受容体は、共刺激(シグナル伝達)ドメインを含むことで、それらの効力が高められる。米国特許第7,741,465号及び同第6,319,494号、並びにKrause et al.及びFinney et al.(上記参照)、Song et al., Blood 119:696-706 (2012)、Kalos et al., Sci. Transl. Med. 3:95 (2011)、Porter et al., N. Engl. J. Med. 365:725-33 (2011)、及びGross et al., Annu. Rev. Pharmacol. Toxicol. 56:59-83 (2016)を参照のこと。
適切なCARは、抗原(例えば、細胞表面抗原)に結合するように、その標的となる抗原と相互作用する抗原結合分子を導入することによって操作され得る。幾つかの実施形態においては、抗原結合分子は、その抗体フラグメント、例えば1種以上の単鎖抗体フラグメント(「scFv」)である。scFvは、互いに連結された抗体の重鎖及び軽鎖の可変領域を有する単鎖抗体フラグメントである。米国特許第7,741,465号及び同第6,319,494号、並びにEshhar et al., Cancer Immunol Immunotherapy (1997) 45: 131-136を参照のこと。scFvは、親抗体の標的抗原と特異的に相互作用する能力を維持している。scFvは、キメラ抗原受容体において有用である。それというのも、scFvは、その他のCAR成分と一緒に単鎖の一部として発現されるように操作され得るからである。同上。Krause et al., J. Exp. Med., Volume 188, No. 4, 1998 (619-626)、Finney et al., Journal of Immunology, 1998, 161: 2791-2797も参照のこと。抗原結合分子は、典型的には、対象となる抗原を認識して結合することができるようにCARの細胞外部分の範囲内に含まれることを理解されたい。対象となる2つ以上の標的に特異性を有する二重特異性及び多重特異性のCARが、本発明の範囲内で考慮される。
本開示の細胞は、被験体から得られるT細胞を通じて得ることができる。T細胞は、例えば末梢血単核細胞、骨髄、リンパ節組織、臍帯血、胸腺組織、感染部位に由来する組織、腹水、胸水、脾臓組織、及び腫瘍から得られてもよい。さらに、T細胞は、当該技術分野において利用可能な1以上のT細胞株に由来し得る。また、T細胞は、FICOLL(商標)分離及び/又はアフェレーシス等の当業者に知られている数多くの技術を使用して被験体から収集された血液単位から得られてもよい。幾つかの実施形態では、アフェレーシスによって収集された細胞を洗浄して血漿画分を除去し、後の処理に適切なバッファー又は培地に入れる。幾つかの実施形態では、細胞をPBSで洗浄する。理解されるように、洗浄工程は、例えばCobe(商標)2991細胞処理装置、Baxter CytoMate(商標)等の半自動フロースルー遠心分離機等を使用することによって使用され得る。幾つかの実施形態では、洗浄された細胞を1以上の生体適合性のバッファー、又はバッファーを含む若しくは含まない他の生理食塩水溶液に再懸濁する。幾つかの実施形態では、アフェレーシス試料の望ましくない成分が除去される。T細胞療法用にT細胞を単離する追加の方法は、米国特許出願公開第2013/0287748号に開示され、その全体が引用することにより本明細書の一部をなす。
本明細書に開示される方法は、被験体において癌を治療するため、腫瘍のサイズを減少させるため、腫瘍細胞を死滅させるため、腫瘍細胞増殖を予防するため、腫瘍の成長を予防するため、患者から腫瘍を排除するため、腫瘍の再燃を予防するため、腫瘍転移を予防するため、患者において寛解を誘導するため、又はそれらの任意の組み合わせに使用され得る。幾つかの実施形態では、上記方法は完全奏功を誘導する。他の実施形態では、上記方法は部分奏功を誘導する。
幾つかの実施形態においては、本明細書に記載される操作されたT細胞を使用することで、患者における悪性腫瘍が治療され、それには(a)1つ以上のキメラ受容体を有する複数のT細胞を得ることと、(b)予め決められた量の多機能性T細胞を含む有効用量の上記T細胞を上記患者に投与することとが含まれる。
幾つかの実施形態においては、キメラ受容体T細胞免疫療法薬の投与は、認可された医療機関で行われる。
幾つかの実施形態においては、上記方法は、有害反応の管理を含む。幾つかの実施の形態においては、有害反応は、サイトカイン放出症候群(CRS)、神経毒性、過敏反応、重症感染、血球減少症、及び低ガンマグロブリン血症からなる群から選択される。
幾つかの実施形態においては、上記方法は、多機能性CAR T細胞のパーセンテージを調整することによって、キメラ受容体治療においてCRSを予防又はその重症度を軽減することを含む。幾つかの実施形態においては、多機能性T細胞は、患者に投与した後に不活性化される。
幾つかの実施形態においては、上記方法は、患者を神経毒性の徴候及び症候についてモニタリングすることを含む。幾つかの実施形態においては、上記方法は、神経症状のその他の原因を除外することを含む。グレード2以上の神経毒性を経験している患者は、連続的な心電図遠隔測定法及びパルスオキシメトリーを用いてモニタリングされるべきである。重度又は生命を脅かす神経毒性の場合には集中治療の支援療法が提供される。
幾つかの実施形態においては、CD19指向性遺伝子改変自己T細胞免疫療法で治療された患者は、二次性悪性腫瘍を発症する場合がある。幾つかの実施形態においては、上記方法は、二次性悪性腫瘍について生涯にわたりモニタリングすることを含む。
注入前のCAR T細胞産物の多機能性プロファイルは、臨床応答及び毒性と関連性がある
本研究(NCT00924326)のコホートは、最近記載された臨床転帰を有する22人の患者を含んでいた。22人の治療される患者のうち、19人は、びまん性大細胞型B細胞リンパ腫(DLBCL)を有し、2人は濾胞性リンパ腫を有し、そして1人は、マントル細胞リンパ腫を有していた(表1)。DLBCLを有する19人の患者のうち、11人は、化学療法不応性のリンパ腫を有していた。DLBCLを有するその他の5人の患者は、プロトコル登録前の最後の治療としての自家幹細胞移植(ASCT)後10ヶ月以内に再発したリンパ腫を有していた。DLBCLを有する11人の患者は、セカンドラインの年齢調整国際予後指数(Hamlin, P.A. et al. Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood 102, 1989-1996.)によれば高リスクであった。プロトコル登録前に受けた特有のリンパ腫療法の数の中央値は4であった(範囲は1〜7)。客観的応答(OR)は、Cheson 2014の基準(Cheson et al. Journal of Clinical Oncology 32, no. 27 (September 2014) 3059-3067)により定義される部分的(PR)又は完全(CR)な応答として定義される。安定(SD)及び進行(PD)は、客観的応答の欠如に相当する(ノンレスポンダー)。このコホートにおける20人の患者からの産物を、単一細胞マルチプレックスサイトカインプロファイリングによって評価することができた。NE及びサイトカイン放出症候群(CRS)を、以前に報告されたように格付けした(Kochenderfer, J.N. et al. Lymphoma remissions caused by anti-CD19 chimeric antigen receptor T cells are associated with high serum interleukin-15 levels. J Clin Oncol 35, 1803-1813 (2017). Epub 2017 Mar 14.)。表1に示されるように、評価可能な患者の主要な背景情報的特性は、年齢、性別、及び腫瘍組織学(びまん性大細胞型B細胞リンパ腫(DLBCL)、形質転換濾胞性リンパ腫(TFL)、マントル細胞リンパ腫(MCL)、濾胞性リンパ腫(FL))、Chesonの基準による最良の応答(BRESP)、及び被験体がグレード3+の神経毒性(表1においてNTが付けられる)又はグレード3+のサイトカイン放出症候群(表1においてCRSが付けられる)を有したかどうかである。
フローサイトメトリーによるscFvの表面発現により測定される、約40%〜60%のCAR陽性T細胞を含む凍結保存されたCAR T細胞産物を解凍し、IL−2(10ng/mL、Biolegend社)を有する細胞療法システム(Cell Therapy Systems)(CTS)完全培地中で1×106/mLの密度で37℃の5%のCO2インキュベーター中で培養した。一晩回復させた後に、Ficoll−Paque Plus培地(Fisher Scientific社)を使用して、生存T細胞を富化した。CD4+/CD8+T細胞サブセットを、抗CD4又は抗CD8のマイクロビーズ(Miltenyi Biotec社、ドイツ、ベルギッシュ・グラートバハ)を使用して分離し、次いでCD19又は神経増殖因子受容体(NGFR)のいずれかが1:2の比率で形質導入されたK562細胞で20時間にわたり37℃の5%のCO2で刺激した。共培養されたCD4+又はCD8+T細胞を、抗CD19又は抗NGFR結合磁気ビーズを使用することによるCD19−K562又はNGFR−K562細胞の除去によって更に富化した。CD4+又はCD8+CAR T細胞の存在を確認するために、Alexa Fluor 647結合抗CD4又は抗CD8抗体を用いて室温で10分間にわたり試料を染色し、リン酸緩衝生理食塩水(PBS)で1回すすぎ、そしてCTS完全培地中で1×106/mLの密度で再懸濁させた。およそ30μLの細胞懸濁液を、単細胞セクレトミクス評価用の単一細胞のバーコードチップ(SCBC)マイクロチップにロードした。
血液中のCAR T細胞増殖を、qPCRによって測定した。各患者について、治療前及び治療後の複数の時点で回収された末梢血単核細胞(PBMC)からDNAを抽出した。DNAを、Qiagen DNeasy blood and tissue kit(Qiagen社、ドイツ、ヒルデン)を使用して抽出した。各時点からのDNAを、CARに特異的なプライマー及びプローブのセット(Applied Biosystems社、カリフォルニア州、フォスターシティ)を用いて2連で増幅させた。リアルタイムPCRを、Roche Light Cycler 480リアルタイムPCRシステム(Roche Diagnostics Corp社、インディアナ州、インディアナポリス)を用いて実施した。DNAの連続1:5希釈を、各患者の注入されたT細胞から同じ患者の治療前のDNA中へと行い、このDNAに対してqPCRを実行することにより検量線を作成した。
共培養実験は、CAR T細胞産物と1:1で混ざったCD19又はNGFR(ネガティブコントロール)を発現するように操作されたK562細胞を使用して実施した。細胞培養培地を、インキュベート24時間後に採取して、引き続き分析した。31個の分析物を、Meso Scale Discovery(MSD(商標)、メリーランド州、ロックビル)、MULTI−SPOT(商標)、及びEMD Millipore社(マサチューセッツ州、バーリントン)のLuminex(商標)xMAP(商標)マルチプレックスアッセイによって評価した。血清IL−15を、EMD Millipore社のLuminex(商標)xMAP(商標)マルチプレックスアッセイを用いて測定した。データ取得及び解析を、Luminex 200(商標)機器及びxPONENT(商標)3.1データ解析ソフトウェアを使用して実施した。
エピジェネティック分析は、以前に特徴付けられた方法(Baron, U. et al. DNA demethylation in the human FOXP3 locus discriminates regulatory T cells from activated FOXP3(+) conventional T cells. Eur J Immunol 37, 2378-2389 (2007))に基づいて実施した。ゲノムDNAを、培養された動物細胞のためのプロトコルに従ってDNeasy tissue kit(Qiagen社)を使用して単離した。ゲノムDNAのバイサルファイト処理を実施した。PCRは、1×PCRバッファー、1UのTaq DNAポリメラーゼ(Qiagen社)、200μmol/LのdNTP、それぞれ12.5pmolのフォワードプライマー及びリバースプライマー、並びに7ngのバイサルファイト処理されたゲノムDNAを含有する25μLの最終容量中で、95℃で15分間と、95℃で1分間、55℃で45秒間、及び72℃で1分間の40サイクルと、72℃で10分間の最終伸長工程とで実施した。PCR産物を、ExoSAP−IT(USB Corp.社、オハイオ州、クリーブランド)を使用して精製し、PCRプライマー及びABI Big Dye Terminator v1.1−chemistry(Applied Biosystems社)を適用することによってシーケンシングを行い、それに続いてABI 3100ジェネティックアナライザにおいてキャピラリー電気泳動を行った。ESMEを使用して、AB1ファイルを解釈した。
CD4、CD8、及びセントラルメモリーについて、表現型をフローサイトメトリーによって決定した(Kochenderfer, et al. B-cell depletion and remissions of malignancy along with cytokine-associated toxicity in a clinical trial of anti-CD19 chimeric-antigen-receptor-transduced T cells. Blood 119, 2709-20 (2012))。CAR陽性CD3+の事象をゲーティングし、メモリーマーカーCCR7及びCD45RAを発現する細胞のパーセンテージを決定した。適切なアイソタイプコントロール抗体を、全ての実験において使用した。使用されたメモリー抗体は、抗CD45RA(eBioscience社、カリフォルニア州、サンディエゴ、クローンHI100)及び抗CCR7(R&D Systems社、クローン150503)であった。
Vi−CELL自動セルカウンター(Beckman Coulter社、カリフォルニア州、ブレア)を使用して、凍結保存してから解凍した細胞を数えた。生細胞懸濁液を、ヒト免疫応答をプロファイリングする770プレックスの遺伝子及び30プレックスのタンパク質発現パネルであるNanoString社のVantage 3D RNA:Protein Immune Cell Profiling Panel(ワシントン州、シアトル)へのインプットとして使用した。CD19−K562又はNGFR−K562試料の場合に、RNAのために50000個の細胞を使用し、タンパク質のために100000個の細胞を使用した。K562+CAR T細胞の共培養物の場合に、RNAのために150000個の細胞を使用し、タンパク質のために200000個の細胞を使用した。CAR T細胞の場合に、RNAのために300000個の細胞を使用し、タンパク質のために200000個の細胞を使用した。抗CD19 CARに特異的なプローブを含む191種の追加の免疫及び代謝関連マーカーのカスタム遺伝子発現パネルも、RNA:タンパク質アッセイのために作られた細胞溶解物に対して実行した。生データをMAXデジタルアナライザーからnSolverソフトウェアv3.0へとインポートした。イメージング、結合密度、ポジティブコントロールの線形性、及び検出限界を評価する標準的な品質管理チェックを実施した。パネルにおける内部ポジティブコントロールを利用することによって、遺伝子及びタンパク質発現の生データをまず正規化した。次いで、mRNAデータをさらに、安定的に発現される一連の参照遺伝子の幾何平均によって正規化し、タンパク質データを、安定的に発現される一連のタンパク質の幾何平均によって正規化した。バックグラウンドを下回って発現されたmRNA及びタンパク質は、ネガティブコントロールの平均値+標準偏差(SD)の2倍(mRNAの場合)、及び免疫グロブリンG−ネガティブコントロールの幾何平均の3倍(タンパク質の場合)のカットオフを使用して分析から除外した。
注入後に、CAR T細胞は急速に増殖し、最初の7日〜14日以内にピークレベルが存在する。注入後1ヶ月間にピーク及び累積レベルとして測定されるCAR T細胞の増殖は、OR及びグレード3+のNTと関連性があるが、グレード3+のCRSとは関連性がない。
Claims (69)
- 患者における悪性腫瘍を治療する方法であって、
(a)1つ以上のキメラ受容体を有する複数のT細胞を得ることと、
(b)予め決められた量の多機能性T細胞を含む有効用量の前記T細胞を前記患者に投与することと、
を含む、方法。 - 前記予め決められた量の多機能性T細胞は、15%超、20%超、20%超、25%超、30%超の多機能性T細胞である、請求項1に記載の方法。
- 多機能性T細胞の前記予め決められた量は、多機能性強度インデックス(PSI)を使用して決定される、請求項1に記載の方法。
- 前記多機能性強度インデックス(PSI)は、前記多機能性細胞のパーセンテージに、該多機能性細胞により分泌されるタンパク質の平均蛍光強度の合計を掛けることによって計算される、請求項3に記載の方法。
- 前記多機能性強度インデックス(PSI)は、250超、350超、450超、又は550超である、請求項3又は4に記載の方法。
- 前記多機能性強度インデックス(PSI)は、(i)多機能性T細胞の所望のパーセンテージを決定することと、(ii)予め決められたサイトカインプロファイルを得ることとを含む方法によって得られる、請求項3〜5のいずれか一項に記載の方法。
- 前記有効用量は、PSI×注入されたT細胞の単位において、少なくとも3.5×1010又は少なくとも7.7×1010を含む、請求項3〜6のいずれか一項に記載の方法。
- 前記予め決められた量の多機能性T細胞は、少なくとも2.4×107個又は少なくとも4.2×107個の多機能性T細胞を含む、請求項1〜7のいずれか一項に記載の方法。
- 前記有効用量は、腫瘍負荷と比例して調節される、請求項1〜8のいずれか一項に記載の方法。
- 多機能性T細胞の前記予め決められた量は、コンポジットインデックスを使用して決定される、請求項1〜9のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、少なくとも2つの評価指標を含む、請求項10に記載の方法。
- 前記評価指標は、各評価指標をそれらの各々の標準偏差によって割ることにより正規化される、請求項11に記載の方法。
- 前記コンポジットインデックスは、多機能性強度インデックス(PSI)及び/又はT細胞注入前の患者のIL−15の血清レベルを含む、請求項10〜12のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、前記多機能性強度インデックス(PSI)を決定することと、前記T細胞注入前の患者のIL−15の血清レベルを測定することとを含む方法によって得られる、請求項10〜13のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、3超である、請求項10〜14のいずれか一項に記載の方法。
- 前記予め決められたサイトカインプロファイルを得ることは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の少なくとも1つを測定することを含む、請求項6〜15のいずれか一項に記載の方法。
- 前記予め決められたサイトカインプロファイルを得ることは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の少なくとも1つを選択することを含む、請求項6〜16のいずれか一項に記載の方法。
- 前記キメラ受容体は、腫瘍抗原を標的とする、請求項1〜17のいずれか一項に記載の方法。
- 前記キメラ受容体は、腫瘍関連表面抗原、例えば5T4、アルファフェトプロテイン(AFP)、B7−1(CD80)、B7−2(CD86)、BCMA、B−ヒト絨毛膜性生殖腺刺激ホルモン、CA−125、癌胚抗原(CEA)、癌胚抗原(CEA)、CD123、CD133、CD138、CD19、CD20、CD22、CD23、CD24、CD25、CD30、CD33、CD34、CD4、CD40、CD44、CD56、CD8、CLL−1、c−Met、CMV特異抗原、CS−1、CSPG4、CTLA−4、DLL3、ジシアロガングリオシドGD2、膵管上皮ムチン、EBV特異抗原、EGFR変異体III(EGFRvIII)、ELF2M、エンドグリン、エフリンB2、上皮増殖因子受容体(EGFR)、上皮細胞接着分子(EpCAM)、上皮性腫瘍抗原、ErbB2(HER2/neu)、線維芽細胞関連タンパク質(fap)、FLT3、葉酸結合タンパク質、GD2、GD3、細胞膠腫関連抗原、スフィンゴ糖脂質、gp36、HBV特異抗原、HCV特異抗原、HER1−HER2、HER2−HER3の組み合わせ、HERV−K、高分子量黒色腫関連抗原(HMW−MAA)、HIV−1型エンベロープ糖タンパク質gp41、HPV特異抗原、ヒトテロメラーゼ逆転写酵素、IGFI受容体、IGF−II、IL−11Rアルファ、IL−13R−a2、インフルエンザウイルス特異抗原、CD38、インスリン増殖因子(IGFI)−1、腸カルボキシルエステラーゼ、カッパー鎖、LAGA−1a、ラムダ鎖、ラッサ熱ウイルス特異抗原、レクチン反応性AFP、系譜特異又は組織特異抗原、例えばCD3、MAGE、MAGE−A1、主要組織適合性複合体(MHC)分子、腫瘍特異的ペプチドエピトープを提示する主要組織適合性複合体(MHC)分子、M−CSF、黒色腫関連抗原、メソテリン、メソテリン、MN−CA IX、MUC−1、mut hsp70−2、変異p53、変異p53、変異ras、好中球エラスターゼ、NKG2D、Nkp30、NY−ESO−1、p53、PAP、プロスターゼ、前立腺特異抗原(PSA)、前立腺癌腫瘍抗原−1(PCTA−1)、前立腺特異抗原タンパク質、STEAP1、STEAP2、PSMA、RAGE−1、ROR1、RU1、RU2(AS)、表面接着分子、サバイビング及びテロメラーゼ、TAG−72、フィブロネクチンのエクストラドメインA(EDA)及びエクストラドメインB(EDB)、並びにテネイシンCのA1ドメイン(TnC A1)、サイログロブリン、腫瘍間質抗原、血管内皮増殖因子受容体−2(VEGFR2)、ウイルス特異表面抗原、例えばHIV特異抗原(例えば、HIV gp120)、並びにこれらの表面マーカーの任意の誘導体又は変異体から選択される腫瘍抗原を標的とする、請求項1〜18のいずれか一項に記載の方法。
- 前記キメラ受容体は、特異的にCD19を標的とする、請求項1〜19のいずれか一項に記載の方法。
- 前記キメラ受容体は、キメラ抗原受容体(CAR)である、請求項1〜20のいずれか一項に記載の方法。
- 前記キメラ受容体は、T細胞受容体(TCR)である、請求項1〜21のいずれか一項に記載の方法。
- 前記悪性腫瘍は、固形腫瘍、肉腫、癌腫、リンパ腫、多発性骨髄腫、ホジキン病、非ホジキンリンパ腫(NHL)、原発性縦隔大細胞型B細胞リンパ腫(PMBC)、びまん性大細胞型B細胞リンパ腫(DLBCL)、濾胞性リンパ腫(FL)、形質転換濾胞性リンパ腫、脾辺縁帯リンパ腫(SMZL)、慢性若しくは急性の白血病、急性骨髄性白血病、慢性骨髄性白血病、急性リンパ芽球性白血病(ALL)(非T細胞ALLを含む)、慢性リンパ性白血病(CLL)、T細胞リンパ腫、1つ以上のB細胞急性リンパ性白血病(「BALL」)、T細胞急性リンパ性白血病(「TALL」)、急性リンパ性白血病(ALL)、慢性骨髄性白血病(CML)、B細胞前リンパ球性白血病、芽球性形質細胞様樹状細胞腫瘍、バーキットリンパ腫、びまん性大細胞型B細胞リンパ腫、濾胞性リンパ腫、毛様細胞白血病、小細胞型若しくは大細胞型濾胞性リンパ腫、悪性リンパ増殖性状態、MALTリンパ腫、マントル細胞リンパ腫、辺縁帯リンパ腫、骨髄異形成及び骨髄異形成症候群、形質芽球性リンパ腫、形質細胞様樹状細胞腫瘍、ワルデンストレームマクログロブリン血症、形質細胞増殖性障害、例えば、無症候性骨髄腫(くすぶり型多発性骨髄腫又は無痛性骨髄腫)、意義不明の単クローン性γグロブリン血症(MGUS)、形質細胞腫(例えば、形質細胞異常増殖症、孤在性骨髄腫、孤在性形質細胞腫、髄外性形質細胞腫、及び多発性形質細胞腫)、全身性アミロイド軽鎖アミロイドーシス、POEMS症候群(Crow−Fukase症候群、高月病、及びPEP症候群としても知られる)、又はそれらの組み合わせである、請求項1〜22のいずれか一項に記載の方法。
- 前記悪性腫瘍は、びまん性大細胞型B細胞リンパ腫(DLBCL)、原発性縦隔大細胞型B細胞リンパ腫、高悪性度B細胞リンパ腫、非ホジキンリンパ腫、転移性黒色腫、形質転換濾胞性リンパ腫、濾胞性リンパ腫、マントル細胞リンパ腫、及び多発性骨髄腫である、請求項1〜23のいずれか一項に記載の方法。
- 前記悪性腫瘍は、非ホジキンリンパ腫である、請求項1〜24のいずれか一項に記載の方法。
- 前記多機能性CAR T細胞は、少なくとも2種のタンパク質又はサイトカインを一度に同時分泌する、請求項1〜25のいずれか一項に記載の方法。
- 前記タンパク質又はサイトカインは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の1つ以上を含む、請求項26に記載の方法。
- 前記悪性腫瘍は、びまん性大細胞型B細胞リンパ腫(DLBCL)、原発性縦隔大細胞型B細胞リンパ腫、高悪性度B細胞リンパ腫、非ホジキンリンパ腫、転移性黒色腫、形質転換濾胞性リンパ腫、濾胞性リンパ腫、マントル細胞リンパ腫、及び多発性骨髄腫の少なくとも1つから選択される、請求項1〜27のいずれか一項に記載の方法。
- 全体用量を調整することで、多機能性細胞の総数を調節することを更に含む、請求項1〜28のいずれか一項に記載の方法。
- 全体用量を調整することで、全体の多機能性強度インデックス(PSI)を調節することを更に含む、請求項1〜29のいずれか一項に記載の方法。
- 患者における悪性腫瘍を治療する方法であって、
(a)1つ以上のキメラ受容体を有する複数のT細胞を得ることと、
(b)前記T細胞の多機能性強度インデックス(PSI)を測定することと、
(c)予め決められた量の多機能性T細胞を含む有効用量を準備することと、
(d)前記患者に、前記予め決められた量の多機能性T細胞を含む有効用量を投与することと、
を含む、方法。 - 多機能性T細胞の前記予め決められた量を最適化することで、治療に応答性である患者の可能性を高める、請求項31に記載の方法。
- 患者がキメラ受容体治療に応答性であるかどうかを決定する方法であって、
(a)キメラ受容体を有する複数のT細胞を得ることと、
(b)前記複数のT細胞中の多機能性T細胞の量を決定することと、
(c)患者がキメラ受容体治療に応答性であるかどうかを、前記多機能性T細胞の量に基づいて決定することと、
を含む、方法。 - 患者における悪性腫瘍を治療する方法であって、
(a)1つ以上のキメラ受容体を有する複数のT細胞を得ることと、
(b)予め決められた量の多機能性T細胞を含む有効用量を準備することと、
(c)前記患者に、前記予め決められた量の多機能性T細胞を含む有効用量を投与することと、
を含む、方法。 - 前記予め決められた量の多機能性T細胞は、15%超、20%超、20%超、25%超、30%超の多機能性T細胞である、請求項31〜34のいずれか一項に記載の方法。
- 多機能性T細胞の前記予め決められた量は、多機能性強度インデックス(PSI)を使用して決定される、請求項31〜34のいずれか一項に記載の方法。
- 前記多機能性強度インデックス(PSI)は、前記多機能性細胞のパーセンテージに、該多機能性細胞により分泌されるタンパク質の平均蛍光強度の合計を掛けることによって計算される、請求項31〜36のいずれか一項に記載の方法。
- 前記多機能性強度インデックス(PSI)は、250超、350超、450超、又は550超である、請求項31〜37のいずれか一項に記載の方法。
- 前記多機能性強度インデックス(PSI)は、(i)多機能性T細胞の所望のパーセンテージを決定することと、(ii)予め決められたサイトカインプロファイルを得ることとを含む方法によって得られる、請求項31〜38のいずれか一項に記載の方法。
- 前記有効用量は、PSI×注入されたT細胞の単位において、少なくとも3.5×1010又は少なくとも7.7×1010を含む、請求項31〜39のいずれか一項に記載の方法。
- 前記予め決められた量の多機能性T細胞は、少なくとも2.4×107個又は少なくとも4.2×107個の多機能性T細胞である、請求項31〜40のいずれか一項に記載の方法。
- 前記有効用量は、腫瘍負荷と比例して調節される、請求項31〜41のいずれか一項に記載の方法。
- 多機能性T細胞の前記予め決められた量は、コンポジットインデックスを使用して決定される、請求項31〜42のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、少なくとも2つの評価指標を含む、請求項43に記載の方法。
- 前記評価指標は、各評価指標をそれらの各々の標準偏差によって割ることにより正規化される、請求項44に記載の方法。
- 前記コンポジットインデックスは、多機能性強度インデックス(PSI)及び/又はT細胞注入前の患者のIL−15の血清レベルを含む、請求項43〜45のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、多機能性強度インデックス(PSI)を決定することと、T細胞注入前の患者のIL−15の血清レベルを測定することとを含む方法により得られる、請求項43〜46のいずれか一項に記載の方法。
- 前記コンポジットインデックスは、3超である、請求項43〜47のいずれか一項に記載の方法。
- 前記予め決められたサイトカインプロファイルを得ることは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の少なくとも1つを測定することを含む、請求項39〜48のいずれか一項に記載の方法。
- 前記予め決められたサイトカインプロファイルを得ることは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の少なくとも1つを選択することを含む、請求項39〜49のいずれか一項に記載の方法。
- 前記キメラ受容体は、腫瘍抗原を標的とする、請求項31〜50のいずれか一項に記載の方法。
- 前記キメラ受容体は、腫瘍関連表面抗原、例えば5T4、アルファフェトプロテイン(AFP)、B7−1(CD80)、B7−2(CD86)、BCMA、B−ヒト絨毛膜性生殖腺刺激ホルモン、CA−125、癌胚抗原(CEA)、癌胚抗原(CEA)、CD123、CD133、CD138、CD19、CD20、CD22、CD23、CD24、CD25、CD30、CD33、CD34、CD4、CD40、CD44、CD56、CD8、CLL−1、c−Met、CMV特異抗原、CS−1、CSPG4、CTLA−4、DLL3、ジシアロガングリオシドGD2、膵管上皮ムチン、EBV特異抗原、EGFR変異体III(EGFRvIII)、ELF2M、エンドグリン、エフリンB2、上皮増殖因子受容体(EGFR)、上皮細胞接着分子(EpCAM)、上皮性腫瘍抗原、ErbB2(HER2/neu)、線維芽細胞関連タンパク質(fap)、FLT3、葉酸結合タンパク質、GD2、GD3、細胞膠腫関連抗原、スフィンゴ糖脂質、gp36、HBV特異抗原、HCV特異抗原、HER1−HER2、HER2−HER3の組み合わせ、HERV−K、高分子量黒色腫関連抗原(HMW−MAA)、HIV−1型エンベロープ糖タンパク質gp41、HPV特異抗原、ヒトテロメラーゼ逆転写酵素、IGFI受容体、IGF−II、IL−11Rアルファ、IL−13R−a2、インフルエンザウイルス特異抗原、CD38、インスリン増殖因子(IGFI)−1、腸カルボキシルエステラーゼ、カッパー鎖、LAGA−1a、ラムダ鎖、ラッサ熱ウイルス特異抗原、レクチン反応性AFP、系譜特異又は組織特異抗原、例えばCD3、MAGE、MAGE−A1、主要組織適合性複合体(MHC)分子、腫瘍特異的ペプチドエピトープを提示する主要組織適合性複合体(MHC)分子、M−CSF、黒色腫関連抗原、メソテリン、メソテリン、MN−CA IX、MUC−1、mut hsp70−2、変異p53、変異p53、変異ras、好中球エラスターゼ、NKG2D、Nkp30、NY−ESO−1、p53、PAP、プロスターゼ、前立腺特異抗原(PSA)、前立腺癌腫瘍抗原−1(PCTA−1)、前立腺特異抗原タンパク質、STEAP1、STEAP2、PSMA、RAGE−1、ROR1、RU1、RU2(AS)、表面接着分子、サバイビング及びテロメラーゼ、TAG−72、フィブロネクチンのエクストラドメインA(EDA)及びエクストラドメインB(EDB)、並びにテネイシンCのA1ドメイン(TnC A1)、サイログロブリン、腫瘍間質抗原、血管内皮増殖因子受容体−2(VEGFR2)、ウイルス特異表面抗原、例えばHIV特異抗原(例えば、HIV gp120)、並びにこれらの表面マーカーの任意の誘導体又は変異体から選択される腫瘍抗原を標的とする、請求項31〜51のいずれか一項に記載の方法。
- 前記キメラ受容体は、特異的にCD19を標的とする、請求項31〜52のいずれか一項に記載の方法。
- 前記キメラ受容体は、キメラ抗原受容体(CAR)である、請求項31〜53のいずれか一項に記載の方法。
- 前記キメラ受容体は、T細胞受容体(TCR)である、請求項31〜54のいずれか一項に記載の方法。
- 前記悪性腫瘍は、固形腫瘍、肉腫、癌腫、リンパ腫、多発性骨髄腫、ホジキン病、非ホジキンリンパ腫(NHL)、原発性縦隔大細胞型B細胞リンパ腫(PMBC)、びまん性大細胞型B細胞リンパ腫(DLBCL)、濾胞性リンパ腫(FL)、形質転換濾胞性リンパ腫、脾辺縁帯リンパ腫(SMZL)、慢性若しくは急性の白血病、急性骨髄性白血病、慢性骨髄性白血病、急性リンパ芽球性白血病(ALL)(非T細胞ALLを含む)、慢性リンパ性白血病(CLL)、T細胞リンパ腫、1つ以上のB細胞急性リンパ性白血病(「BALL」)、T細胞急性リンパ性白血病(「TALL」)、急性リンパ性白血病(ALL)、慢性骨髄性白血病(CML)、B細胞前リンパ球性白血病、芽球性形質細胞様樹状細胞腫瘍、バーキットリンパ腫、びまん性大細胞型B細胞リンパ腫、濾胞性リンパ腫、毛様細胞白血病、小細胞型若しくは大細胞型濾胞性リンパ腫、悪性リンパ増殖性状態、MALTリンパ腫、マントル細胞リンパ腫、辺縁帯リンパ腫、骨髄異形成及び骨髄異形成症候群、形質芽球性リンパ腫、形質細胞様樹状細胞腫瘍、ワルデンストレームマクログロブリン血症、形質細胞増殖性障害、例えば、無症候性骨髄腫(くすぶり型多発性骨髄腫又は無痛性骨髄腫)、意義不明の単クローン性γグロブリン血症(MGUS)、形質細胞腫(例えば、形質細胞異常増殖症、孤在性骨髄腫、孤在性形質細胞腫、髄外性形質細胞腫、及び多発性形質細胞腫)、全身性アミロイド軽鎖アミロイドーシス、POEMS症候群(Crow−Fukase症候群、高月病、及びPEP症候群としても知られる)、又はそれらの組み合わせである、請求項31〜55のいずれか一項に記載の方法。
- 前記悪性腫瘍は、びまん性大細胞型B細胞リンパ腫(DLBCL)、原発性縦隔大細胞型B細胞リンパ腫、高悪性度B細胞リンパ腫、非ホジキンリンパ腫、転移性黒色腫、形質転換濾胞性リンパ腫、濾胞性リンパ腫、マントル細胞リンパ腫、及び多発性骨髄腫である、請求項31〜56のいずれか一項に記載の方法。
- 前記悪性腫瘍は、非ホジキンリンパ腫である、請求項31〜57のいずれか一項に記載の方法。
- 前記多機能性CAR T細胞は、少なくとも2種のタンパク質又はサイトカインを一度に同時分泌する、請求項31〜58のいずれか一項に記載の方法。
- 前記タンパク質又はサイトカインは、グランザイムB、IFN−γ、MIP1a、パーフォリン、TNFa、TNFb、GMCSF、IL−2、IL−5、IL−7、IL−8、IL−9、IL−12、IL−15、IL−21、CCI−11、IP−10、MIP1b、RANTES、IL−4、IL−10、IL−13、IL−22、TGF−b1、SCD137、SCD40L、IL−1b、IL−6、IL−17a、IL−17f、MCP−1、及びMCP−4の1つ以上を含む、請求項59に記載の方法。
- 前記悪性腫瘍は、びまん性大細胞型B細胞リンパ腫(DLBCL)、原発性縦隔大細胞型B細胞リンパ腫、高悪性度B細胞リンパ腫、非ホジキンリンパ腫、転移性黒色腫、形質転換濾胞性リンパ腫、濾胞性リンパ腫、マントル細胞リンパ腫、及び多発性骨髄腫の少なくとも1つから選択される、請求項31〜60のいずれか一項に記載の方法。
- 全体用量を調整することで、多機能性細胞の総数を調節することを更に含む、請求項31〜61のいずれか一項に記載の方法。
- 全体用量を調整することで、全体の多機能性強度インデックス(PSI)を調節することを更に含む、請求項31〜62のいずれか一項に記載の方法。
- キメラ受容体治療の効力を高める方法であって、多機能性CAR T細胞のパーセンテージを調整することを含む、方法。
- 前記多機能性T細胞を選択及び単離することを含む、請求項64に記載の方法。
- 1つ以上のキメラ受容体を有する複数のT細胞を含む医薬組成物であって、予め決められた量の多機能性T細胞を含む、医薬組成物。
- 15%超の多機能性T細胞を含む、請求項66に記載の医薬組成物。
- 20%超の多機能性T細胞を含む、請求項66に記載の医薬組成物。
- 25%超の多機能性T細胞を含む、請求項66に記載の医薬組成物。
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JP2020537635A (ja) * | 2017-09-15 | 2020-12-24 | カイト ファーマ インコーポレイテッドKite Pharma, Inc | 継続管理及び継続識別による生体サンプル追跡を用いた患者固有の免疫療法手順を実施する方法及びシステム |
SG11202011541SA (en) | 2018-06-01 | 2020-12-30 | Kite Pharma Inc | Chimeric antigen receptor t cell therapy |
US11271741B2 (en) | 2018-11-29 | 2022-03-08 | Vineti Inc. | Centralized and decentralized individualized medicine platform |
US11321652B1 (en) | 2019-02-20 | 2022-05-03 | Vineti Inc. | Smart label devices, systems, and methods |
CN111690730B (zh) * | 2019-03-14 | 2024-02-09 | 中国科学院上海巴斯德研究所 | Il-8阳性初始t细胞作为诊断胸腺占位性疾病的靶点的应用 |
US20210145885A1 (en) * | 2019-10-16 | 2021-05-20 | Northwestern University | Materials and methods for treating vitiligo |
WO2021150078A1 (ko) | 2020-01-23 | 2021-07-29 | 주식회사 강스템바이오텍 | Off-the-shelf 줄기세포 및 면역세포, 이를 포함하는 약학적 조성물 |
US11615874B1 (en) | 2021-09-30 | 2023-03-28 | Vineti Inc. | Personalized medicine and therapies platform |
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CA3057880A1 (en) | 2018-10-11 |
TW201902493A (zh) | 2019-01-16 |
AU2018250148A1 (en) | 2019-10-17 |
AR111360A1 (es) | 2019-07-03 |
IL269629A (en) | 2019-11-28 |
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JP2022166297A (ja) | 2022-11-01 |
EP3655022A1 (en) | 2020-05-27 |
US20220265721A1 (en) | 2022-08-25 |
KR20220144888A (ko) | 2022-10-27 |
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