Determining toxicity risk in CAR T-cell therapy
Provided herein are methods, compositions and articles of manufacture for use in connection with cell therapy involving the administration of one or more doses of a therapeutic T cell composition. The cells of the T cell composition express recombinant receptors such as chimeric receptors, e.g. chimeric antigen receptors (CARs) or other transgenic receptors such as T cell receptors (TCRs). Features of the provided embodiments, including the numbers of cells or units of cells administered and/or the potency of administered cells, provide various advantages, such as lower risk of toxicity in subjects administered the T cell compositions.
1. A method of ameliorating the development of a toxicity in a subject, the method comprising administering to the subject an agent capable of treating the development of a toxicity that is severe cytokine release syndrome (CRS) or severe neurotoxicity, wherein the subject has been administered a dose of about 1.0×10 7 to about 1×10 8 total CAR-expressing T cells expressing a recombinant receptor that is a chimeric antigen receptor (CAR), wherein the subject is treated, following assessment of the number of recombinant-receptor expressing T cells in a blood sample of the subject, when:
assessment of the subject determines that a peak expansion of the recombinant receptor-expressing T cells occurs within or within about seven days of administration of the dose, wherein the peak expansion of the recombinant receptor-expressing T cells occurring within or within about seven days of administration of the dose indicates the subject is at risk of developing a toxicity; and wherein the agent is a steroid or an IL-6 or IL-6 receptor inhibitor, or a combination thereof.
2. The method of claim 1 , wherein the subject is at risk of developing the toxicity if, further, the level, amount or concentration of interleukin-15 (IL-15) detected in a blood or serum sample from the subject is at or above a threshold value.
3. The method of claim 2 , wherein the threshold value is 30 pg/mL.
4. The method of claim 2 , wherein the sample is obtained from the subject at or about no more than 5 days following initiation of administration of the cell therapy.
5. The method of claim 1 , wherein the severe neurotoxicity is at least a prolonged grade 3 neurotoxicity, a grade 4 neurotoxicity, or a grade 5 neurotoxicity.
6. The method of claim 1 , wherein the toxicity is or is associated with cerebral edema.
7. The method of claim 1 , wherein the steroid is a corticosteroid.
8. The method of claim 7 , wherein the corticosteroid is a glucocorticoid.
9. The method of claim 8 , wherein the glucocorticoid is dexamethasone.
10. The method of claim 1 , wherein the agent is tocilizumab, siltuximab, sarilumab, olokizumab (CDP6038), elsilimomab, ALD518/BMS-945429, sirukumab (CNTO 136), CPSI-2634, ARGX-109, FE301 or FM101.
11. The method of claim 1 , wherein the dose is about 2.5×10 7 to about 1×10 8 total CAR-expressing T cells.
12. The method of claim 1 , wherein the dose is a fixed dose.
13. The method of claim 1 , wherein the CAR targets an antigen associated with a B cell malignancy.
14. The method of claim 13 , wherein the B cell malignancy is selected from the group consisting of acute lymphoblastic leukemia (ALL), adult ALL, chronic lymphocytic leukemia (CLL), non-Hodgkin lymphoma (NHL) and diffuse large B-cell lymphoma (DLBCL).
15. The method of claim 1 , wherein the CAR targets an antigen that is CD20, CD19, CD22, ROR1, CD45, CD21, CD5, CD33, Igkappa, Iglambda, CD79a, CD79b or CD30.
16. A method of ameliorating the development of a toxicity in a subject, the method comprising administering to the subject an agent capable of treating the development of a toxicity that is severe cytokine release syndrome (CRS) or severe neurotoxicity, wherein the subject has been administered a dose of about 1.0×10 7 to about 1×10 8 total CAR-expressing T cells expressing a recombinant receptor that is a chimeric antigen receptor (CAR), wherein the subject is treated, following assessment of the number of recombinant receptor-expressing cells in a blood sample of the subject, when:
(a) no more than four days after initiation of the dose of the recombinant receptor-expressing T cells, the number of recombinant receptor-expressing cells in the blood sample of the subject is at least at or about 2 recombinant receptor-expressing cells per microliter;
(b) no more than five or six days after initiation of the dose of the recombinant receptor-expressing T cells, the number of recombinant receptor-expressing cells in the blood sample of the subject is at least at or about 5 recombinant receptor-expressing cells per microliter; or
(c) no more than seven days after initiation of the administration the number of recombinant receptor-expressing cells in the blood sample of the subject is at least at or about 15 recombinant receptor-expressing cells per microliter; and wherein the agent is a steroid or an IL-6 or IL-6 receptor inhibitor, or a combination thereof.
17. The method of claim 16 , wherein the subject is at risk of developing the toxicity if, further, the level, amount or concentration of interleukin-15 (IL-15) detected in a blood or serum sample from the subject is at or above a threshold value.
18. The method of claim 17 , wherein the threshold value is 30 pg/mL.
19. The method of claim 17 , wherein the sample is obtained from the subject at or about no more than 5 days following initiation of administration of the cell therapy.
20. The method of claim 16 , wherein the severe neurotoxicity is at least a prolonged grade 3 neurotoxicity, a grade 4 neurotoxicity, or a grade 5 neurotoxicity.
21. The method of claim 16 , wherein the assessment of the subject determines that no more than five or six days after initiation of the administration the number of recombinant receptor-expressing T cells in the blood sample of the subject is at least at or about 10 recombinant receptor-expressing cells per microliter.
22. The method of claim 16 , wherein the assessment comprises use of a nucleic acid- or flow cytometry-based detection method.
23. The method of claim 22 , wherein nucleic acid-based detection method comprises use a quantitative polymerase chain reaction (qPCR)-based detection method.
24. The method of claim 16 , wherein the toxicity is or is associated with cerebral edema.
25. The method of claim 16 , wherein the steroid is a corticosteroid.
26. The method of claim 25 , wherein the corticosteroid is a glucocorticoid.
27. The method of claim 26 , wherein the glucocorticoid is dexamethasone.
28. The method of claim 16 , wherein the agent is tocilizumab, siltuximab, sarilumab, olokizumab (CDP6038), elsilimomab, ALD518.