Methods and compositions for infusion of transiently engrafting, selected populations of allogeneic lymphocytes to treat cancer
The invention provides methods and compositions for administration of allogeneic lymphocytes as an exogenous source of CD4+ T cell help for endogenous, tumor-reactive CD8+ T cells. Depletion of CD8+ T cells from the donor lymphocyte infusion reduces the risk of sustained engraftment and graft-versus-host disease. Removal of regulatory T cells from the infused population may augment the ability of non-regulatory T cells to provide help for endogenous effectors of anti-tumor immunity. Allogeneic T cell therapy is typically given in the context of allogeneic stem cell transplantation, in which the patient receives highly immunosuppressive conditioning followed by an infusion of a stem cell graft containing unselected populations of mature T cells. In the treatment described here, the graft is engineered to minimize the possibility of sustained donor cell engraftment, and the anti-tumor effector T cells derive from the host.
1. A method of treating a disease or condition in a human subject, comprising:
administering a lymphoreductive non-lymphoablative treatment to the subject to induce transient lymphopenia in the subject; and
subsequently administering to the subject a first allogenic lymphocyte composition derived from a peripheral blood cell composition of a human, allogenic donor, the first allogenic lymphocyte composition comprising a number of CD4+ T-cells and a number of natural killer cells from the peripheral blood cell composition of the donor, wherein the number of CD4+ T-cells in the first allogenic lymphocyte composition differs from the number of CD4+ T-cells in the peripheral blood cell composition by less than about 50%; the number of natural killer cells in the first allogenic lymphocyte composition is less than or equal to the number of natural killer cells in the peripheral blood cell composition, and the first allogenic lymphocyte composition has at least one order of magnitude fewer CD8+ T-cells relative to the peripheral blood cell composition, wherein
(i) the donor comprises at least one human leukocyte antigen (HLA) Class II allele mismatch relative to the subject in the donor versus the subject direction and the HLA Class II allele mismatch is at a gene selected from the group consisting of HLA-DRB1, HLA-DQB1, and HLA-DPB1,
(ii) the subject does not have detectable antibodies reactive against human leukocyte antigens of the donor,
with the proviso that the CD4+ T-cells of the first allogenic lymphocyte composition are not activated ex vivo, and
wherein the disease or condition is selected from the group consisting of a neoplasm and cancer.
2. The method of claim 1 , wherein the lymphoreductive non-lymphoablative treatment comprises treating the subject with one or more cytoreductive agent selected from the group consisting of alkylating agents, alkyl sulphonates, nitrosoureas, triazenes, antimetabolites, pyrimidine analogs, purine analogs, vinca alkaloids, epipodophyllotoxins, antibiotics, dibromomannitol, deoxyspergualine, dimethyl myleran and thiotepa.
3. The method of claim 1 , wherein subsequent to administering the first allogenic lymphocyte composition to the subject, the method further comprises administration of an anti-tumor monoclonal antibody or anti-tumor monoclonal antibody/drug conjugate to the subject.
4. The method of claim 1 , wherein subsequent to administering the first allogenic lymphocyte composition to the subject, the method further comprises
administering a successive lymphoreductive non-lymphoablative treatment to the subject to induce transient lymphopenia in the subject; and
subsequently administering to the subject a successive allogenic lymphocyte composition derived from an additional peripheral blood cell composition of an additional human, allogenic donor, the successive allogenic lymphocyte composition comprising a number of CD4+ T-cells and a number of natural killer cells from the additional peripheral blood cell composition of the additional donor, wherein
(i) the additional donor comprises at least one human leukocyte antigen (HLA) Class II allele mismatch relative to the subject in the additional donor versus the subject direction and the HLA Class II allele mismatch is at a gene selected from the group consisting of HLA-DRB1, HLA-DQB1, and HLA-DPB1,
(ii) the subject does not have detectable antibodies reactive against human leukocyte antigens of the additional donor,
(iii) the number of CD4+ T-cells in the successive allogenic lymphocyte composition differs from the number of CD4+ T-cells in the additional peripheral blood cell composition by less than about 50%,
(iv) the number of additional donor CD4+ T-cells based on an ideal body weight of the subject in kilograms (kg) is between about 1×10 5 CD4+ T-cells/kg and about 1×10 9 CD4+ T-cells/kg,
(v) the number of natural killer cells in the successive allogenic lymphocyte composition is less than or equal to the number of natural killer cells in the additional peripheral blood cell composition, and
(vi) the successive allogenic lymphocyte composition has at least one order of magnitude fewer CD8+ T-cells relative to the additional peripheral blood cell composition.
5. The method of claim 4 , with the proviso that the CD4+ T-cells of the successive allogenic lymphocyte composition are not activated ex vivo.
6. The method of claim 1 , wherein the disease or condition is a cancer and the cancer is myelodysplastic syndrome.
7. The method of claim 1 , wherein
(iii) the number of donor CD4+ T-cells based on an ideal body weight of the subject in kilograms (kg) is between about 1×10 5 CD4+ T-cells/kg and about 1×10 9 CD4+ T-cells/kg.
8. The method of claim 2 , wherein the lymphoreductive non-lymphoablative treatment comprises treating the subject with an alkylating agent and the alkylating agent is cyclophosphamide.
9. The method of claim 3 , wherein the method further comprises administration of the anti-tumor monoclonal antibody and the anti-tumor monoclonal antibody is selected from the group consisting of rituximab, cetuximab, trastuzumab, bevacizumab, panitumumab and pertuzumab.
10. The method of claim 3 , wherein the method further comprises administration of the anti-tumor monoclonal antibody/drug conjugate and the anti-tumor monoclonal antibody/drug conjugate is selected from the group consisting of brentuximab vedotin, gemtuzumab ozogamicin, trastuzumab emtansine, inotuzumab ozogamicin, glembatumumab vedotin, lorvotuzumab mertansine, cantuzumab mertansine, and milatuzumab-doxorubicin.
11. The method of claim 1 , wherein subsequent to administering the first allogenic lymphocyte composition to the subject, the method further comprises administration of a chemotherapeutic agent to the subject.
12. The method of claim 11 , wherein the chemotherapeutic agent is selected from the group consisting of dasatinib, nilotinib, ponatinib, imatinib, lapatinib, and vismodegib.
13. The method of claim 1 , wherein subsequent to administering the first allogenic lymphocyte composition to the subject, the method further comprises administration of a monoclonal antibody/CD4+ T-cell epitope conjugate to the subject.
14. The method of claim 1 , wherein subsequent to administering the first allogenic lymphocyte composition to the subject, the method further comprises administration of an agent that blocks negative signaling in T-cells.
15. The method of claim 14 , wherein the agent that blocks negative signaling in T-cell is selected from the group consisting of an anti-PD-1 antibody, ipilimumab, an anti-PD-L2 antibody, and a PD-1 fusion protein.