Treatment of acute lymphoblastic leukemia
The present invention relates to a method for the treatment, amelioration or elimination of acute lymphoblastic leukemia (ALL), the method comprising the administration of a pharmaceutical composition comprising a CD19×CD3 bispecific single chain antibody construct to an adult patient in the need thereof.
1. A method for treating acute lymphoblastic leukemia (ALL) minimal residual disease (MRD) in an adult patient in hematological remission, the method comprising
selecting the patient in hematological remission; and
administering to the patient an effective amount of a composition comprising a CD19×CD3 bispecific single chain antibody construct comprising a variable heavy chain anti-CD19 CDR1 comprising the amino acid sequence set forth in SEQ ID NO: 14, a variable heavy chain anti-CD19 CDR2 comprising the amino acid sequence set forth in SEQ ID NO: 15, a variable heavy chain anti-CD19 CDR3 comprising the amino acid sequence set forth in SEQ ID NO: 16, a variable light chain anti-CD19 CDR1 comprising the amino acid sequence set forth in SEQ ID NO: 11, a variable light chain anti-CD19 CDR2 comprising the amino acid sequence set forth in SEQ ID NO: 12, a variable light chain anti-CD19 CDR3 comprising the amino acid sequence set forth in SEQ ID NO: 13, a variable heavy chain anti-CD3 CDR1 comprising the amino acid sequence set forth in SEQ ID NO: 17, a variable heavy chain anti-CD3 CDR2 comprising the amino acid sequence set forth in SEQ ID NO: 18, a variable heavy chain anti-CD3 CDR3 comprising the amino acid sequence set forth in SEQ ID NO: 19; a variable light chain anti-CD3 CDR1 comprising the amino acid sequence set forth in SEQ ID NO: 20, a variable light chain anti-CD3 CDR2 comprising the amino acid sequence set forth in SEQ ID NO: 21, and a variable light chain anti-CD3 CDR3 comprising the amino acid sequence set forth in SEQ ID NO: 22,
wherein treatment results in stable disease or converts MRD-positive ALL into MRD-negative ALL.
2. The method of claim 1 , wherein said acute lymphoblastic leukemia (ALL) is B-lineage acute lymphoblastic leukemia.
3. The method of claim 1 , wherein said acute lymphoblastic leukemia (ALL) is refractory to chemotherapy.
4. The method of claim 1 , further comprising administering an allogeneic hematopoietic stem cell transplantation.
5. The method of claim 1 , wherein MRD is measured with quantitative detection of individual rearrangements of immunoglobulin genes or T-cell receptor (TCR) rearrangements, or by bcr/abl fusion transcripts, or by t(4;11) translocations using PCR or FACS analysis.
6. The method of claim 5 , wherein the ALL patient shows a bcr/abl or a t(4;11) translocation signal above detection limit and/or at least one marker by rearrangement with a sensitivity of ≥10 −4 .
7. The method of claim 1 , wherein the corresponding variable heavy chain regions (V H ) and the corresponding variable light chain regions (V L ) in said CD19×CD3 bispecific single chain antibody construct are arranged, from N-terminus to C-terminus, in the order, V L (CD19)-V H (CD19)-V H (CD3)-V L (CD3).
8. The method of claim 7 , wherein said CD19×CD3 bispecific single chain antibody construct comprises the amino acid sequence set forth in SEQ ID NO: 1.
9. The method of claim 1 , wherein one treatment cycle is a 4-week continuous infusion, followed by repeated cycles after a 2-week treatment-free interval.
10. The method of claim 9 , wherein the treatment cycle is repeated at least three times, after determination of a MRD negative status (consolidation).
11. The method of claim 1 , wherein the CD19×CD3 bispecific single chain antibody construct is to be administered in a daily dose of 10 μg to 100 μg per square meter patient body surface area.
12. The method of claim 11 , wherein the CD19×CD3 bispecific single chain antibody construct is to be administered in a daily dose of 15 μg to 30 μg per square meter patient body surface area.
13. The method of claim 2 , wherein said B-lineage acute lymphoblastic leukemia is B-precursor acute lymphoblastic leukemia.
14. The method of claim 7 , wherein said CD19×CD3 bispecific single chain antibody construct comprises an amino acid sequence at least 90% identical to the amino acid sequence set forth in SEQ ID NO: 1.
15. The method of claim 7 , wherein said CD19×CD3 bispecific single chain antibody construct comprises an amino acid sequence at least 95% identical to the amino acid sequence set forth in SEQ ID NO: 1.
16. The method of claim 9 , wherein the at least four weeks of continuous infusion is followed by at least a 2-week treatment-free interval.
17. The method of claim 10 , wherein each treatment cycle is followed by at least a 2-week treatment-free interval.
18. The method of claim 1 , wherein the CD19×CD3 bispecific single chain antibody construct comprises a variable heavy chain anti-CD19 amino acid sequence set forth in SEQ ID NO: 3 and a variable light chain anti-CD19 amino acid sequence set forth in SEQ ID NO: 5.
19. The method of claim 1 , wherein the CD19×CD3 bispecific single chain antibody construct comprises a variable heavy chain anti-CD3 amino acid sequence set forth in SEQ ID NO: 7 and a variable light chain anti-CD3 amino acid sequence set forth in SEQ ID NO: 9.
20. The method of claim 1 , wherein the CD19×CD3 bispecific single chain antibody construct comprises a variable heavy chain anti-CD19 amino acid sequence set forth in SEQ ID NO: 3, a variable light chain anti-CD19 amino acid sequence set forth in SEQ ID NO: 5, a variable heavy chain anti-CD3 amino acid sequence set forth in SEQ ID NO: 7, and a variable light chain anti-CD3 amino acid sequence set forth in SEQ ID NO: 9.
21. The method of claim 1 , wherein the CD19×CD3 bispecific single chain antibody construct is encoded by the nucleic acid sequence set forth in SEQ ID NO: 2.