Kimmel Cancer Center immunology and bone marrow transplant expert Ivan Borrello has developed a novel personalized cancer treatment approach called adoptive T cell therapy using the patients’ own immune cells to fight their cancer. This approach uses cells from the bone marrow known as marrow infiltrating lymphocytes, or MILs.
T cells are the foot soldiers of the immune system, and MILs are a type of tumor-specific T cell, a small subset of immune cells that recognize cancer cells. In cancers of the blood, MILs are found in the bone marrow where the cancer originates. In this new approach, our scientists retrieve patients’ own MILs from their bone marrow, expand their numbers and coat the cells with immune-activating antibodies in a special Cell Therapy Lab at Johns Hopkins, and then infuse them back into the patient’s bloodstream where they seek out and destroy cancer cells.
Borrello is using MILs therapy to treat patients with an incurable cancer of the blood plasma cells known as multiple myeloma. In a first-of-its-kind clinical trial of the therapy, 22 patients with newly diagnosed or recurrent multiple myeloma received the therapy. Following standard treatment for multiple myeloma—high-dose chemotherapy to destroy the diseased bone marrow—and a stem cell transplant to repopulate the marrow with normal blood and immune cells, patients were given their own MILs.
One year after MILs therapy, 13 patients had at least a 50 percent reduction in their cancer. Their cancer remained stable for nearly a year, and overall survival was close to three years. Seven patients saw a 90 percent reduction, and their cancer has remained in check for more than six years. There were no serious side effects to the therapy. “This was a small trial, but we learned that large numbers of activated MILs can selectively target and kill myeloma cells,” says Borello.
There is currently an ongoing clinical trial targeting myeloma patients with high risk features. Borrello and team hope to determine if the approach can impact patients where standard approaches are ineffective. The trial will soon be extended to other cancer centers.
Borrello and collaborator Kimberly Noonan, a research associate in the school of medicine, say the studies shed light on better ways to grown MILs. “In most of these trials, you see that the more cells you get, the better response you get in patients. Learning how to improve cell growth may improve the outcomes of therapy,” says Noonan.
The research indicates that MILs could also be beneficial in the treatment of a variety of other cancers, so Borrello has involved a team of heavy hitters to help advance the science and clinical reach beyond myeloma. Other plans include administering MILs in patients that have relapsed following an allogeneic bone marrow transplant, using MILs from the patient grown and expanded in the laboratory, rather than immune cells from the bone marrow donor. MILs are being developed to treat lung, esophageal, gastric cancers as well as prostate cancer in adults and neuroblastoma and Ewing’s sarcoma in pediatric patients. The team includes of some of the Kimmel Cancer Center’s leading experts in immunology, blood and bone marrow cancer, and experts in specific cancers, including Drew Pardoll, Carol Ann Huff, Leo Luznik, William Matsui, Jonathan Powell, Ephraim Fuchs, Richard Ambinder, Richard Jones, Ronan Kelly, Nate Brennan, and Brian Ladle.