Therapeutic targeting of CD19 in hematological malignancies: past, present, future and beyond

Abstract During the past few decades, CD19 has been at the center of various scientific/translational endeavors to develop targeted therapeutics against B-cell malignancies. Due to the expression pattern of CD19 throughout the B-cell lineage, and on most B-cell malignancies, it became a preferred target for the development of experimental therapeutic agents during the first years of the monoclonal antibodies era. Successful preclinical experiments led to the first generation of clinical trials, based predominantly on toxin/anti-CD19 murine immunoconjugates. These, however, mostly failed due to poor biochemical design of the reagents, and the generation of human anti-murine antibodies. Modern anti-CD19 reagents are based on humanized anti-CD19 antibodies designed to attract components of the immune system, predominantly T-cells, to eliminate CD19+ target cells. These include, for example, modified anti-CD19 antibodies, and bispecific anti-CD19/CD3 antibodies. One of the most attractive approaches to target malignant B-cells is based on the introduction of chimeric antigen receptors (CARs) into patient derived T-cells. CARs are composed of extracellular recognition sequences derived from anti-CD19 antibodies, and intracellular signaling components that can foster T-cell activation. The novel anti-B-cell therapeutics have shown promising clinical effects against various B-cell malignancies, including acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), although expected side effects (e.g. significant immunosuppression) were also recorded. These novel successful anti-CD19 agents may have the potential to be used in other fields, such as autoimmunity.