Overview of Cellular Immunotherapies within Transfusion Medicine for the Treatment of Malignant Diseases

Abstract

Over the years, transfusion medicine has developed into a broad, multidisciplinary field that covers different clinical patient services such as apheresis technology and the development of stem cell transplantation. Recently, the discipline has found a niche in development and production of advanced therapy medicinal products (ATMPs) for immunotherapy and regenerative medicine purposes. In clinical trials, cell-based immunotherapies have shown encouraging results in the treatment of multiple cancers and autoimmune diseases. However, there are many parameters such as safety, a high level of specificity, and long-lasting efficacy that still need to be optimized to maximize the potential of cell-based immunotherapies. Thus, only a few have gained FDA approval, while the majority of them are studied in the context of investigator-initiated trials (IITs), where modern, academically oriented transfusion centers can play an important role. In this review, we summarize existing and contemporary cellular immunotherapies, which are already a part of modern transfusion medicine or are likely to become so in the future.

Keywords: cancer; cell-based immunotherapy; transfusion medicine.

Figure 1

Adoptive T-cell therapy. (A) TILs are isolated from excised tumors and expanded with high doses of IL-2. These highly activated TILs are then infused back into the patient following lymphodepleting chemotherapy. (B) In TCR/CAR-based ACT, T cells are isolated by leukapheresis and modified to express either TCR or CAR by gene transfection. Modified T cells are expanded ex vivo and infused into the patient.

Figure 2

Dendritic cell-based immunotherapy. Approaches for generating DCs-based vaccines include direct expansion of circulating DCs, isolation of circulating DC subsets, and differentiation from monocytes or CD34+ progenitor cells. After differentiation, immature DCs are activated with different maturation stimuli and loaded with tumor antigens. Finally, prepared antigen-loaded DCs are injected to the patient.