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Published on: October 16, 2018
Genetic Mutation and Epigenetic Silencing Drive Antigen-Negative Relapse in CD7 CAR-T Treated T-cell Lymphoid
Rongrong Chen1, Haiqiong Zheng2, Wenxin Wang2
1the first Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou China.
Abstract:
CD7 is a promising target for chimeric antigen receptor (CAR) T-cell therapy in T-cell lymphoid malignancies; however, antigen loss-mediated relapse emerged as a major challenge. Herein, we systematically analyzed the genetic and epigenetic alterations of paired specimens (pre-treatment and relapsed) from 10 patients with T-cell lymphoma/leukemia receiving CD7 CAR-T cells. Overall, we identified three distinct mechanisms underlying CD7 loss: Firstly, frameshift insertion (Pt4; c.164dupG:p.R55fs) or deletion (Pt7; c.122delG:p.G41Efs*19) resulting in truncation of the CD7 transmembrane domain in two of ten patients; Secondly, hypermethylation of the CD7 promoter in seven of ten patients without CD7 mutation; Thirdly, simultaneous occurrence of promoter region hypermethylation and multiple in-frame mutations with predicted functional interference in one of ten patients (Pt2). Collectively, these findings demonstrated that both clonal heterogeneity and epigenetic plasticity drive antigen-negative relapse in T-cell lymphoid malignancies under the selective pressure of CD7 CAR-T therapy.
Insights
CD7 CAR-T therapy faces relapse challenges due to antigen loss. This study reveals genetic mutations and promoter hypermethylation as key mechanisms driving CD7 loss in T-cell malignancies.
Area of Science:
- Oncology
- Immunotherapy
- Genetics
Background:
- CD7 is a target for CAR T-cell therapy in T-cell malignancies.
- Antigen loss leading to relapse is a significant challenge in CAR T-cell therapy.
Purpose of the Study:
- To investigate the mechanisms of CD7 loss in patients with T-cell lymphoid malignancies relapsing after CD7 CAR-T cell therapy.
Main Methods:
- Systematic analysis of paired pre-treatment and relapsed specimens from 10 patients.
- Genetic sequencing and epigenetic analysis (promoter methylation) were performed.
Main Results:
- Three mechanisms of CD7 loss were identified: frameshift mutations (2/10 patients), CD7 promoter hypermethylation (7/10 patients), and combined mutations/hypermethylation (1/10 patients).
- Clonal heterogeneity and epigenetic plasticity were observed as drivers of relapse.
Conclusions:
- CD7 loss, driven by genetic mutations and/or epigenetic alterations, is a critical mechanism of relapse in CD7 CAR-T cell therapy for T-cell malignancies.
- Understanding these mechanisms is crucial for developing strategies to overcome antigen-negative relapse.
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