Targeting CD38 is lethal to Breg-like chronic lymphocytic leukemia cells and Tregs, but restores CD8(+) T-cell responses
BLOOD ADVANCES
Authors: Manna, Alak; Kellett, Timothy; Aulakh, Sonikpreet; Lewis-Tuffin, Laura J.; Dutta, Navnita; Knutson, Keith; Chini, Eduardo; Pinilla-Ibarz, Javier; Lamanna, Nicole; Manochakian, Rami; Malavasi, Fabio; Sher, Taimur; Chanan-Khan, Asher A.; Ailawadhi, Sikander; Paulus, Aneel
Abstract
Patients with chronic lymphocytic leukemia (CLL) are characterized by monoclonal expansion of CD5(+) CD23(+) CD27(+) CD19(+) kappa/lambda(+) B lymphocytes and are clinically noted to have profound immune suppression. In these patients, it has been recently shown that a subset of B cells possesses regulatory functions and secretes high levels of interleukin 10 (IL-10). Our investigation identified that CLL cells with a CD19(+) CD24(+) CD38(hi) immununophenotype (B regulatory cell [Breg]-like CLL cells) produce high amounts of IL-10 and transforming growth factor beta (TGF-beta) and are capable of transforming naive T helper cells into CD4(+) CD25(+)FoxP3(+) T regulatory cells (Tregs) in an IL-10/TGF-beta-dependent manner. A strong correlation between the percentage of CD38(+) CLL cells and Tregs was observed. CD38(hi) Tregs comprised more than 50% of Tregs in peripheral blood mononuclear cells (PBMCs) in patients with CLL. Anti-CD38 targeting agents resulted in lethality of both Breg-like CLL and Treg cells via apoptosis. Ex vivo, use of anti-CD38 monoclonal antibody (mAb) therapy was associated with a reduction in IL-10 and CLL patient-derived Tregs, but an increase in interferon-y and proliferation of cytotoxic CD8(+) T cells with an activated phenotype, which showed an improved ability to lyse patient-autologous CLL cells. Finally, effects of anti-CD38 mAb therapy were validated in a CLL-patient-derived xenograft model in vivo, which showed decreased percentage of Bregs, Tregs, and PD1(+)CD38(hi)CD8(+) T cells, but increased Th17 and CD8(+) T cells (vs vehicle). Altogether, our results demonstrate that targeting CD38 in CLL can modulate the tumor microenvironment; skewing T-cell populations from an immunosuppressive to immune-reactive milieu, thus promoting immune reconstitution for enhanced anti-CLL response.
Are there primary intraocular lymphomas that do not develop into central nervous system lymphomas?
JOURNAL OF CLINICAL AND EXPERIMENTAL HEMATOPATHOLOGY
Authors: Matsuo, Toshihiko; Tanaka, Takehiro
Abstract
Primary intraocular lymphomas frequently develop into central nervous system lymphomas and vice versa. This study reviewed 22 consecutive patients with primary intraocular lymphoma diagnosed by immunostaining of vitrectomy cell blocks, and examined whether they developed central nervous system lymphoma. Seventeen patients developed central nervous system lymphoma: 3 patients developed intraocular and central nervous system lymphoma simultaneously, 9 patients developed central nervous system lymphoma 1 month to 5 years (median, 3 months) after intraocular lymphoma, and 5 patients developed central nervous system lymphoma preceding the diagnosis of intraocular lymphoma by 3 months to 9 years and 8 months (median, 1.5 years). In contrast, 5 patients did not develop central nervous system lymphoma: 2 patients did not develop local recurrence or central nervous system lymphoma in the follow-up period of 5 years and 11 years, respectively, after vitrectomy alone without additional local or systemic treatment. The remaining 3 patients with intraocular lymphoma had insufficient follow-up periods to determine the prognosis. The results of CD5 immunostaining of vitrectomy specimens were found in pathology reports of 8 patients: 3 patients with CD5-positive large cells and 4 patients with CD5-negative large cells developed central nervous system lymphoma. In summary, only a small number of patients did not develop central nervous system lymphoma based on long-term follow-up after vitrectomy alone. CD5 was not a marker of central nervous system involvement in this study population.