Chimeric antigen receptor T cells for the treatment of lymphoma
Relapsed Hodgkin lymphoma (HL) and non-HL (NHL) are heterogeneous and diverse diseases that have poor outcomes. Concomitant comorbidity and/or toxicity from previous chemotherapy often restrict these patients from receiving salvage chemotherapy and/or allogeneic hematopoietic stem cell transplantation (HSCT). Adoptive T-cell immunotherapy has been tested in lymphomas; however, down-regulation of major histocompatibility complex (MHC) on the surface of tumor or cancer cell-mediated T cell suppression can limit success with this approach. Recent advances in genetic engineering allow efficient introduction of a synthetic chimeric antigen receptor (CAR) into T cells that recognizes specific antigen(s) expressed on tumor cells independent of MHC which, together with improved manufacturing techniques, led to the development of highly active cellular therapy utilizing autologous or allogeneic T cells resulting in impressive response and remission rates in relapsed and chemorefractory lymphomas. We will review the structure of CAR, the results of the landmark clinical trials utilizing CAR T cell therapy for the treatment of lymphomas and new strategies in the CAR T cell therapy.