JP2022522914A - 医学的使用 - Google Patents
医学的使用 Download PDFInfo
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- JP2022522914A JP2022522914A JP2021510533A JP2021510533A JP2022522914A JP 2022522914 A JP2022522914 A JP 2022522914A JP 2021510533 A JP2021510533 A JP 2021510533A JP 2021510533 A JP2021510533 A JP 2021510533A JP 2022522914 A JP2022522914 A JP 2022522914A
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Abstract
Description
(i)NK細胞および/またはNK様T細胞を含む組成物であって、NK細胞および/またはNK様T細胞が、本明細書において定義される通りである、組成物と、
(ii)本明細書において定義される抗ウイルス剤と、を含む、キットオブパーツを提供する。
概論
多発性骨髄腫(MM)の治療のための新薬の開発は、生存率を以前の約3年から現在の5年超まで大幅に改善させた。しかしながら、この劇的な改善にもかかわらず、同種幹細胞移植(AlloSCT)で治療された若い患者の一部の考えられる例外を除き、治癒は実際には得られない。したがって、新しいアプローチが重要である。
6人の患者は、評価および最後の注入後6か月のフォローアップを含む試験を完了した(図1)。臨床結果のプロトコルに従った中間分析は、安全性データが十分であると判断されるので、試験を終了する選択肢で確定されており、あるいは継続し、追加の6人の患者を選定する。
臨床試験の状態
6人の患者は、プロトコルに従って有効なCellProtect治療を完了し、プロトコルに従って要求された累積数の活性化されたNK細胞を3回注入した。これらの6人の患者は、訪問7で評価され、その後6か月のフォローアップを完了した。
患者は、診断時に臨床試験に含まれ、患者の人口統計データは、表1に示される。5人の患者はIgG骨髄腫(103、105、106、107、111)を有し、1人はIgA骨髄腫(110)を有した。ASCT後およびNK細胞注入前の奏効状態は、3人の患者(103、105、107)において非常に良好な部分奏効(VGPR)であり、3人の患者(106、110、111)において完全奏効(CR)であった。CellProtectの製造のための出発材料は、任意のMM治療の開始前に、第1の試験訪問時に献血によって収集される。
第2の試験訪問は、ASCT後、CellProtectの注入前の検査訪問である。この訪問の目的は、MM奏効基準、表2に従って患者の分類を確立すること、患者が依然として適格であり、治療を試験し続けるために十分であることを確認するために、患者の健康状態についての情報を収集することである。骨髄試料は、患者からの同意を得て、この訪問時に採取されるべきであり、CellProtect治療の評価のためのベースラインBMサンプリングを構成する。訪問3での用量前の患者の状態は、ほとんどの他の評価のベースラインとして機能する。
患者103は、ASCT治療に対する非常に良好な部分奏効(VGPR)に分類され、移植の6~8週間後、CellProtectの3回の完全用量が注入された。M成分血清レベルの低減は、CellProtect注入後に以前の8g/Lから1g/L(>80%低減)まで、試験期間にわたって低いままであった。
CellProtect治療の臨床的有効性の兆候は、これまで疾患の確立されたバイオマーカーである、血清免疫グロブリンレベルを測定することによって監視された(図2)。血清免疫グロブリンレベルの低減は、残存する測定可能な疾患を有する全て(3人)の患者においてCellProtectの投与後に測定され、ASCT後に安定な部分奏効(VGPR)または(VGPR)であった。6人の患者のうちの3人は、完全寛解(CR)であり、CellProtect治療時に測定可能なレベルの血清免疫グロブリンを有さなかった。免疫グロブリンレベルの増加は、これまでCellProtectで治療された6人の患者のうちの1人において測定された(図2)。
深刻な副作用は見られなかった。しかしながら、最初の4人の患者(103、105、106、および107)は、ASCTの18~32週間後、および第1のNK細胞注入の3~25週間後に帯状ヘルペス(HZ、帯状疱疹)を発症した(図3)。これらの患者は、臨床慣行に従ったウイルス再活性化の予防として、ASCT後14週間にわたって毎日バラシクロビル250mgx2を受けた。薬物は次いで中止され、よってNK細胞注入後にHZが発症した時期をカバーしなかった。
我々の結果は、自家増殖および活性化されたNK細胞は安全であるが、抗ウイルス薬が予防のために使用されない限り、HZ再活性化を誘導することを示す。
CellProtectの製造
CellProtect製剤は、MMを有する患者からのエクスビボ増殖NK細胞をベースにした細胞懸濁液である。治療は、自家である。
1.Alici E,Bjorkstrand B,Treschow A,Aints A,Smith CI,Gahrton G,et al.Long-term follow-up of gene-marked CD34+ cells after autologous stem cell transplantation for multiple myeloma.Cancer Gene Ther.2007;14(3):227-32.
2.Alici E,Sutlu T,Bjorkstrand B,Gilljam M,Stellan B,Nahi H,et al.Autologous antitumor activity by NK cells expanded from myeloma patients using GMP-compliant components.Blood.2008;111(6):3155-62.
3.Alici E,Konstantinidis KV,Sutlu T,Aints A,Gahrton G,Ljunggren HG,et al.Anti-myeloma activity of endogenous and adoptively transferred activated natural killer cells in experimental multiple myeloma model.Exp Hematol.2007;35(12):1839-46.
4.Sutlu T,Stellan B,Gilljam M,Quezada HC,Nahi H,Gahrton G,et al.Clinical-grade,large-scale,feeder-free expansion of highly active human natural killer cells for adoptive immunotherapy using an automated bioreactor.Cytotherapy.2010;12(8):1044-55.
5.Backstrom E,Chambers BJ,Ho EL,Naidenko OV,Mariotti R,Fremont DH,et al.Natural killer cell-mediated lysis of dorsal root ganglia neurons via RAE1/NKG2D interactions.European journal of immunology.2003;33(1):92-100.
6.Backstrom E,Chambers BJ,Kristensson K,Ljunggren HG.Direct NK cell-mediated lysis of syngenic dorsal root ganglia neurons in vitro.Journal of immunology.2000;165(9):4895-900.
7.Hickey WF,Ueno K,Hiserodt JC,Schmidt RE.Exogenously-induced,natural killer cell-mediated neuronal killing:a novel pathogenetic mechanism.The Journal of experimental medicine.1992;176(3):811-7.
8.Park H,Youk J,Kim HR,Koh Y,Kwon JH,Yoon SS,et al.Infectious complications in multiple myeloma receiving autologous stem cell transplantation in the past 10 years.International journal of hematology.2017;106(6):801-10.
9.Park S,Jung CW,Jang JH,Kim SJ,Kim WS,Kim K.Incidence of infection according to intravenous immunoglobulin use in autologous hematopoietic stem cell transplant recipients with multiple myeloma.Transpl Infect Dis.2015;17(5):679-87.
以下の実施例は、有効成分が抗ウイルス剤である本発明による薬学的製剤を示す。
以下の制御放出カプセル製剤は、押出機を使用して成分a、b、およびcを押し出し、続いて押出物を球状化し、乾燥させることによって調製される。次いで、乾燥ペレットを放出制御膜(d)でコーティングし、2ピース硬質ゼラチンカプセルに充填する。
有効成分 0.200g
滅菌、パイロジェンフリーリン酸緩衝液(pH7.0)~10ml
有効成分を、ほとんどのリン酸緩衝液(35~40℃)に溶解し、次いで体積を調整し、滅菌マイクロポアフィルターを通して滅菌10mlアンバーガラスバイアル(タイプ1)に濾過し、滅菌閉鎖およびオーバーシールで密封する。
Claims (40)
- 患者におけるヘルペスウイルス再活性化の防止における使用のための抗ウイルス剤であって、前記患者が、ナチュラルキラー(NK)細胞および/またはNK様T細胞を含む療法を受けており、前記使用が、前記抗ウイルス剤を、前記NK細胞および/またはNK様T細胞療法を受けている前記患者に投与するステップを含む、使用のための抗ウイルス剤。
- 患者におけるヘルペスウイルス再活性化を防止するための医薬品の製造における抗ウイルス剤の使用であって、前記患者が、ナチュラルキラー(NK)細胞および/またはNK様T細胞を含む療法を受けており、前記抗ウイルス剤が、前記NK細胞および/またはNK様T細胞療法を受けている前記患者に投与される、使用。
- 患者におけるヘルペスウイルス再活性化を防止するための方法であって、前記患者が、ナチュラルキラー(NK)細胞および/またはNK様T細胞を含む療法を受けており、前記方法が、前記抗ウイルス剤を、前記NK細胞および/またはNK様T細胞療法を受けている前記患者に投与するステップを含む、方法。
- 前記NK細胞および/またはNK様T細胞療法が、ヘルペスウイルス再活性化を誘導および/または増加させる、請求項1に記載の使用のための抗ウイルス剤、請求項2に記載の使用、または請求項3に記載の方法。
- 前記患者が、悪性疾患を有する、請求項1~4のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記NK細胞および/またはNK様T細胞療法が、悪性疾患の治療における使用のためのものである、請求項1~5のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記悪性疾患が、血液癌である、請求項5または6に記載の使用のための抗ウイルス剤、方法、または使用。
- 前記血液癌が、骨髄腫、リンパ腫、白血病、および/または慢性骨髄増殖性疾患からなる群から選択されるものである、請求項7に記載の使用のための抗ウイルス剤、方法、または使用。
- 前記NK細胞が、表現型CD3-CD56+を有し、および/または前記NK様T細胞が、表現型CD3+CD56+を有する、請求項1~8のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記NK細胞および/またはNK様T細胞が、エクスビボで増殖されている、請求項1~9のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、前記患者が前記NK細胞および/またはNK様T細胞療法を受ける前および/またはそれと同時におよび/またはその後に投与される、請求項1~10のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記患者が、前記抗ウイルス剤を、前記患者が前記NK細胞および/またはNK様T細胞療法を受ける少なくとも1日前、例えば、前記患者が前記NK細胞および/もしくはNK様T細胞療法を受ける少なくとも2日前、または少なくとも3日前、または少なくとも4日前、または少なくとも5日前、または少なくとも6日前、または少なくとも7日前、または少なくとも8日前、または少なくとも9日前、または少なくとも10日前、または少なくとも20日前、または少なくとも30日前、または少なくとも1か月前に投与される、請求項1~11のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、前記患者が前記NK細胞および/またはNK様T細胞療法を受けた少なくとも1日後、例えば、前記患者が前記NK細胞および/もしくはNK様T細胞療法を受けた少なくとも2日後、または少なくとも3日後、または少なくとも4日後に投与される、請求項1~12のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 500~1500mgの前記抗ウイルス剤が、24時間以内に前記患者に投与される、請求項1~13のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、1回以上の用量で前記患者に投与される、請求項1~14のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、24時間に250~750mgの2回の用量で前記患者に投与され、好ましくは前記抗ウイルス剤が、24時間に500mgの2回の用量で前記患者に投与される、請求項1~15のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、少なくとも1か月、例えば、少なくとも2か月、または少なくとも3か月、または少なくとも4か月、または少なくとも5か月、または少なくとも6か月、または少なくとも7か月の期間にわたって前記患者に投与される、請求項1~16のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記患者が、高用量療法(HDT)および/または自家幹細胞移植(ASCT)後にNK細胞および/またはNK様T細胞療法を受ける、請求項1~17のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記患者が、ASCTの3か月~7か月後、例えば、ASCTの3か月後、またはASCTの4か月後、またはASCTの5か月後、またはASCTの6か月後、またはASCTの7か月後にNK細胞および/またはNK様T細胞療法を受ける、請求項18に記載の使用のための抗ウイルス剤、方法、または使用。
- 前記NK細胞および/またはNK様T細胞療法が、1回、または2回、または3回、または4回、または5回以上のNK細胞および/またはNK様T細胞の投与を含む、請求項1~19のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記NK細胞および/またはNK様T細胞が、前記患者の体重1kgあたり少なくとも5×106細胞、または前記患者の体重1kgあたり少なくとも50×106細胞、または前記患者の体重1kgあたり少なくとも100×106細胞の投与量で投与される、請求項1~20のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、バラシクロビル、アシクロビル、ファムシクロビル、および/もしくはペンシクロビルからなる群から選択されるものなどのヌクレオシド類似体、またはそのようなヌクレオシド類似体の活性代謝物、プロドラッグ、塩、溶媒和物、もしくは水和物を含む、請求項1~21のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記抗ウイルス剤が、経口、静脈内、皮下、および/または筋肉内投与される、請求項1~22のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 水痘帯状疱疹ウイルス(VZV)、単純ヘルペスウイルス(HSV)、エプスタインバーウイルス(EBV)、および/またはサイトメガロウイルス(CMV)を含む群から選択されるヘルペスウイルスが、前記患者に存在する、請求項1~23のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記ヘルペスウイルス再活性化が、前記患者における帯状疱疹を引き起こす、請求項1~24のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 前記患者が、リンパ球枯渇していない、請求項1~25のいずれかに記載の使用のための抗ウイルス剤、方法、または使用。
- 患者における悪性疾患の治療における使用のためのナチュラルキラー(NK)細胞および/またはNK様T細胞であって、前記使用が、NK細胞および/またはNK様T細胞療法を受けている前記患者に抗ウイルス剤を投与するステップを含む、使用のためのNK細胞および/またはNK様T細胞。
- 患者における悪性疾患を治療するための医薬品の製造におけるナチュラルキラー(NK)細胞および/またはNK様T細胞の使用であって、前記患者に、前記NK細胞および/またはNK様T細胞療法と共に抗ウイルス剤が投与される、使用。
- 患者における悪性疾患を治療するための方法であって、ナチュラルキラー(NK)細胞および/またはNK様T細胞を含む療法を投与するステップを含み、前記NK細胞および/またはNK様T細胞療法を受けている前記患者に抗ウイルス剤を投与するステップをさらに含む、方法。
- 前記悪性疾患が、骨髄腫、リンパ腫、白血病、および/または慢性骨髄増殖性疾患からなる群から選択されるものなどの血液癌である、請求項27~29のいずれかに記載の使用のためのナチュラルキラー(NK)細胞および/もしくはNK様T細胞、使用、または方法。
- 前記抗ウイルス剤が、患者におけるヘルペスウイルス再活性化を防止する、請求項27~30のいずれかに記載の使用のためのナチュラルキラー(NK)細胞および/もしくはNK様T細胞、使用、または方法。
- 前記ナチュラルキラー(NK)細胞および/またはNK様T細胞療法が、ヘルペスウイルス再活性化を誘導および/または増加させる、請求項27~31のいずれかに記載の使用のためのNK細胞および/もしくはNK様T細胞、使用、または方法。
- 前記ヘルペスウイルス再活性化が、前記患者における帯状疱疹を引き起こす、請求項31~32のいずれかに記載の使用のためのナチュラルキラー(NK)細胞および/もしくはNK様T細胞、使用、または方法。
- 前記患者が、高用量療法(HDT)および/または自家幹細胞移植(ASCT)後にナチュラルキラー(NK)細胞および/またはNK様T細胞療法を受ける、請求項27~32のいずれかに記載の使用のためのNK細胞および/もしくはNK様T細胞、使用、または方法。
- 前記抗ウイルス剤が、請求項1~34のいずれかにおいて定義される通りである、請求項27~34のいずれかに記載の使用のためのナチュラルキラー(NK)細胞および/もしくはNK様T細胞、方法、または使用。
- 前記ナチュラルキラー(NK)細胞および/またはNK様T細胞療法が、請求項1~35のいずれかにおいて定義される通りである、請求項27~35のいずれかに記載の使用のためのNK細胞および/もしくはNK様T細胞、方法、または使用。
- 請求項1~36のいずれかにおいて定義されるナチュラルキラー(NK)細胞および/またはNK様T細胞と、請求項1~36のいずれかにおいて定義される抗ウイルス剤と、を含む、薬学的組成物。
- (i)ナチュラルキラー(NK)細胞および/またはNK様T細胞を含む組成物であって、前記NK細胞および/またはNK様T細胞が、請求項1~37のいずれかにおいて定義される通りである、組成物と、
(ii)請求項1~37のいずれかにおいて定義される抗ウイルス剤と、を含む、キットオブパーツ。 - 薬学的に許容される希釈剤、担体、または賦形剤をさらに含む、請求項37に記載の薬学的組成物、または請求項38に記載のキット。
- 添付の特許請求の範囲および実施例を参照して本明細書に実質的に記載される、使用のための抗ウイルス剤、使用、方法、薬学的組成物、またはキットオブパーツ。
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