Daratumumab depletes CD38+ immune-regulatory cells, promotes T-cell expansion, and skews T-cell repertoire in multiple myeloma
2016
Daratumumabtargets
CD38-expressing myeloma cells through a variety of immune-mediated mechanisms (
complement-dependent cytotoxicity,
antibody-dependent cell-mediated cytotoxicity, and antibody-dependent cellular phagocytosis) and direct apoptosis with crosslinking. These mechanisms may also target nonplasma cells that express
CD38, which prompted evaluation of daratumumab’s effects on
CD38-positive immune subpopulations. Peripheral blood (PB) and bone marrow (BM) from patients with relapsed/refractory myeloma from 2
daratumumabmonotherapy studies were analyzed before and during therapy and at relapse.
Regulatory B cellsand
myeloid-derived suppressor cells, previously shown to express
CD38, were evaluated for immunosuppressive activity and
daratumumabsensitivity in the myeloma setting. A novel subpopulation of regulatory T cells (Tregs) expressing
CD38was identified. These Tregs were more immunosuppressive in vitro than
CD38-negative Tregs and were reduced in
daratumumab-treated patients. In parallel,
daratumumabinduced robust increases in helper and
cytotoxic T-cellabsolute counts. In PB and BM,
daratumumabinduced significant increases in CD8 + :CD4 + and CD8 + :Treg ratios, and increased
memory T cellswhile decreasing
naive T cells. The majority of patients demonstrated these broad T-cell changes, although patients with a partial response or better showed greater maximum effector and helper T-cell increases, elevated antiviral and alloreactive
functional responses, and significantly greater increases in T-cell clonality as measured by T-cell receptor (TCR) sequencing. Increased TCR clonality positively correlated with increased CD8 + PB T-cell counts. Depletion of
CD38+ immunosuppressive cells, which is associated with an increase in
T-helper cells,
cytotoxic T cells, T-cell
functional response, and TCR clonality, represents possible additional mechanisms of action for
daratumumaband deserves further exploration.
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