Cellular immunotherapy with multiple infusions of in vitro-expanded haploidentical natural killer cells after autologous transplantation for patients with plasma cell myeloma

Background aims: To investigate the feasibility and safety of haploidentical natural killer (NK) cell infusions as consolidation immunotherapy after autologous stemcell transplant (ASCT) in patients with plasma cellmyeloma. Methods: Ten patients (median age, 59 years) received induction treatment followed by high-dose melphalan (200 mg/m(2)) at day -1, ASCT at day 0 and increasing NK cell doses (1.5 x 10(6), 1.5 x 10(7) and multiple doses of 1.0 x 10(8) cells/kg body weight) from day +1 to day +30 after ASCT. NK cells were harvested and purified from peripheral blood of haploidentical donors and expanded for 19 days with interleukin (IL)-2 and IL-15 under Good Manufacturing Practice conditions. Results: NK cell numbers increased 56.0-fold (37.4- to 75.5-fold). Patients received a median of 3.8 x 10(8) (0.9-5.7 x 10(8)) NK cells/kg body weight in six (three to eight) infusions. Multiparametricmass cytometry analysis demonstrated an altered surface receptor repertoire of expanded NK cells with increased degranulation and cytokine production activities but diminished expression of perforin. Donor NK cells were detectable in the peripheral blood, peaking 1 h after each dose (up to 90% donor NK cells). The treatment was safe and well tolerated, without evidence of graft-versus-host disease. Comparison with a control patient population receiving ASCT without NK cell infusions showed no significant difference in relapse, progression-free survival and overall survival. Conclusions: This study demonstrates reliable manufacturing of high numbers of activated NK cells for multiple-dose infusions and safe administration of these cellular products. The trial was registered at ClinicalTrials.gov (identifier no. NCT01040026). (c) 2020 International Society for Cell & Gene Therapy. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

The study demonstrates the feasibility and safety of haploidentical NK cell infusions as consolidation immunotherapy after ASCT in patients with plasma cell myeloma. By manufacturing high numbers of activated NK cells for multiple-dose infusions, the treatment showed expected effects without evidence of graft-versus-host disease.