Diagnostic methods for T cell therapy
The invention provides methods of increasing the efficacy of a T cell therapy in a patient in need thereof. The invention includes methods of identifying a patient who would respond well to a T cell therapy or conditioning a patient prior to a T cell therapy so that the patient responds well to a T cell therapy. The conditioning involves administering one or more preconditioning agents prior to a T cell therapy and identifying biomarker cytokines prior to administering a T cell therapy.
1. A method for treating a lymphoma in a patient suitable for chimeric antigen receptor (CAR) T cell therapy comprising:
(i) administering to the patient one or more preconditioning agents that are capable of decreasing the serum level of Perforin and increasing a serum level of interleukin-15 (“IL-15”), interleukin-7 (“IL-7”), and of at least one additional cytokine selected from the group consisting of monocyte chemotactic protein 1 (“MCP-1”), C-reactive protein (“CRP”), placental growth factor (“PLGF”), interferon gamma-induced protein 10 (“IP-10”), and any combination thereof, wherein the preconditioning agents comprise cyclophosphamide and fludarabine;
and (ii) administering a therapeutically effective amount of anti-CD19 CAR T cell therapy on day zero, wherein the patient has been determined to exhibit a decrease in the serum level of Perforin and an increased serum level of IL-15, IL-7, and the at least one additional cytokine, at day zero, prior to the administration of CAR T cell therapy and relative to their baseline serum levels, wherein the cytokine serum levels have been measured by an enzyme-linked immunosorbent assay (ELISA) or any method that detects the amount of protein in the serum for each cytokine and allows for their quantification, prior to the administration of the preconditioning agents.
2. The method for identifying a patient suitable for anti-CD19 CAR T cell therapy comprising (i) administering to the patient one or more preconditioning agents that are capable of decreasing the serum level of Perforin and increasing a serum level of IL-15, IL-7, and of at least one additional cytokine selected from the group consisting of MCP-1, CRP, PLGF, IP-10, and any combination thereof, wherein the preconditioning agents comprise cyclophosphamide and fludarabine; (ii) measuring the serum levels of Perforin, IL-15, IL-7, and of at least one additional cytokine selected from the group consisting of MCP-1, CRP, PLGF, IP-10, and any combination thereof, at baseline, which is prior to the administration of the preconditioning agent(s), and at day zero, which is after administration of the preconditioning agent(s) and prior to, but on the day of, administration of CAR T cell therapy; wherein the cytokine serum levels have been measured by an enzyme-linked immunosorbent assay (ELISA) or any method that detects the amount of protein in the serum for each cytokine and allows for their quantification; and wherein the patient is selected as suitable for anti-CD19 CAR T cell therapy when there is a decrease in the serum level of Perforin and an increase in the levels of the cytokines measured from the baseline to the day zero measurements; administering to the selected patient anti-CD19 CAR T cell therapy.
3. A method for decreasing the serum level of Perforin and increasing a serum level of IL-15, IL-7, and of at least one additional cytokine selected from the group consisting of MCP-1, CRP, PLGF, IP-10, and any combination thereof to pre-condition a patient in need of anti-CD19 CAR T cell therapy comprising administering to the patient one or more preconditioning agents, wherein the patient is treated with anti-CD19 CAR T cell therapy when exhibiting a decreased serum level of Perforin and an increased serum level of IL-15, IL-7, and of the at least one additional cytokine prior to, but on the day of administration of the therapy, relative to baseline levels prior to pre-conditioning, wherein the cytokine serum levels have been measured by an enzyme-linked immunosorbent assay (ELISA) or any method that detects the amount of protein in the serum for each cytokine and allows for their quantification; and wherein the preconditioning agents comprise cyclophosphamide and fludarabine.
4. The method of any one of claims 1 , 2 , and 3 , wherein:
a. the serum level of IL-7 in the patient is increased at least 6-fold, after the administration compared to the IL-7 serum level prior to the administration of the one or more preconditioning agents;
b. the serum level of IL-15 in the patient is increased at least 18-fold after the administration compared to the IL-15 serum level prior to the administration of the one or more preconditioning agents;
c. the serum level of MCP-1 in the patient is increased at least 2-fold after the administration compared to the MCP-1 serum level prior to the administration of the one or more preconditioning agents;
d. the serum level of PLGF in the patient is increased at least 1.5-fold after the administration compared to the PLGF serum level prior to the administration of the one or more preconditioning agents;
e. the serum level of CRP in the patient is increased at least 1.5-fold after the administration compared to the CRP serum level prior to the administration of the one or more preconditioning agents;
f. the serum level of IP-10 in the patient is increased at least 2-fold after the administration compared to the IP-10 serum level prior to the administration of the one or more preconditioning agents; or
g. any combination thereof.
5. The method of any one of claims 1 , 2 , and 3 , wherein:
(i) a dose of cyclophosphamide administered to the subject is about 300 mg/m 2 /day to about 2000 mg/m 2 /day;
(ii) a dose of fludarabine administered to the subject is about 20 mg/m 2 /day to about 900 mg/m 2 /day; or
(iii) both (i) and (ii).
6. The method of claim 5 , wherein:
(i) a dose of cyclophosphamide administered to the subject is about 350 mg/m 2 /day, about 400 mg/m 2 /day, about 450 mg/m 2 /day, about 500 mg/m 2 /day, about 550 mg/m 2 /day, about 600 mg/m 2 /day, about 650 mg/m 2 /day, about 700 mg/m 2 /day, about 800 mg/m 2 /day, about 900 mg/m 2 /day, or about 1000 mg/m 2 /day;
(ii) a dose of fludarabine administered to the subject is about 25 mg/m 2 /day, about 30 mg/m 2 /day, about 35 mg/m 2 /day, about 40 mg/m 2 /day, about 45 mg/m 2 /day, about 50 mg/m 2 /day, about 55 mg/m 2 /day, about 60 mg/m 2 /day, about 65 mg/m 2 /day, about 70 mg/m 2 /day, about 75 mg/m 2 /day, about 80 mg/m 2 /day, about 85 mg/m 2 /day, about 90 mg/m 2 /day, about 95 mg/m 2 /day, about 100 mg/m 2 /day, about 200 mg/m 2 /day, or about 300 mg/m 2 /day; or
(iii) any combination thereof.
7. The method of claim 5 , wherein:
(i) a dose of cyclophosphamide administered to the subject is about 400 mg/m 2 /day to about 600 mg/m 2 /day and a dose of fludarabine administered to the subject is about 20 to about 40 mg/m 2 /day; or
(ii) a dose of cyclophosphamide administered to the subject is about 900 mg/m 2 /day to about 1000 mg/m 2 /day and a dose of fludarabine administered to the subject is about 25 mg/m 2 /day.
8. The method of claim 5 , wherein a dose of cyclophosphamide is administered daily for about three days.
9. The method of claim 5 , wherein a dose of fludarabine is administered daily for at least two days.
10. The method of claim 1 , further comprising administering one or more doses of IL-2.
11. The method of claim 1 , wherein the anti-CD19 CAR T cell therapy comprises administering engineered anti-CD19 CAR T cells at a dose of about 1×10 6 to about 5×10 6 engineered CAR T cells/kg.
12. The method of claim 1 , wherein the lymphoma is selected diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal (thymic) large B cell lymphoma, DLBCL arising from follicular lymphoma, follicular lymphoma, non-Hodgkin's lymphoma (NHL), B-cell lymphoma, and mantle cell lymphoma.
13. The method of claim 5 , wherein a dose of cyclophosphamide administered to the subject is about 500 mg/m 2 /day and a dose of fludarabine administered to the subject is about 30 mg/m 2 /day.