Table 1.
The influence of different CAR-T targets on the immune system
| Antigen | Expressed on which cells | Effect on the immune system | Tumor Target |
The issue of COVID-19 |
|---|---|---|---|---|
| B-cell leukemia/lymphoma | ||||
| CD19* | Most B-cell malignancies and most normal B-cell lineages |
• B-cell aplasia contributes to hypogammaglobulinemia and impaired humoral immunity • Neutropenia |
B-ALL, DLBCL, FL, MCL |
• High risk of severe/critical • Longer hospitalization [6, 29] • Low serological response rate after vaccination (57%) [37]; may have lower serological response rate compared with BCMA-based CAR-T (76.4%) [38] • Low rates of seroconversion and prolonged viral shedding [39, 40] • Longer duration of COVID-19 symptoms [29] • Prone to reinfection and rebound positivity • May be more likely to give rise to multimutational SARS-CoV-2 variants [41] |
| CD22 | Most B-cell malignancies and most normal B-cell lineages | B-NHL | ||
| CD20 | Most B-cell malignancies and most normal B-cell lineages | B-ALL | ||
| Multiple myeloma | ||||
| BCMA* | Mainly in plasma blast cells and terminally differentiated plasma cells |
• B-cell aplasia contributes to hypogammaglobulinemia and impaired humoral immunity • Neutropenia |
MM, PPCL, POEMS, AL |
• As described above, the concern is that there may be a higher mortality rate (41%) [42] than with CD19 CAR-T (20%) [43] |
| GRPC5D | Highly expressed on normal and malignant plasma cells | MM | ||
| T-cell leukemia/lymphoma | ||||
| CD7 | T cells and natural killer cells and their precursors |
• T-cell aplasia contributes to impaired cellular immunity • Neutropenia |
T-ALL, T-LBL |
• Healthy donor T cells may increase the risk of GVHD after COVID-19 • Delayed viral clearance |
| CD5 | All T cells and B1 cell subset | T-ALL | ||
| Acute myelogenous leukemia | ||||
| CD123 | AML cells; B-ALL cells; HD; hematopoietic stem cells; dendritic cells |
• Effect on hematopoiesis • Damage to hematopoietic stem cells |
AML | • Delayed recovery of hematopoietic function |
| Hodgkin lymphoma | ||||
| CD30 | Highly expressed on HD and anaplastic large-cell lymphoma; activated T cells, B cells and NK cells |
• Affect the balance of the T-cell subsets • Transient neutropenia |
HD | • Delayed viral clearance |
* CAR-T cell products have been approved by the Food and Drug Administration and/or National Medical Products Administration
B-ALL: B-lineage acute lymphoblastic leukemia; DLBCL: diffuse large B-cell lymphoma; FL: follicular lymphoma; MCL: mantle cell lymphoma; B-NHL: B-lineage non-Hodgkin lymphoma; HD: Hodgkin’s lymphoma; T-ALL: T-lineage acute lymphoblastic leukemia; T-LBL: T-lineage lymphoblastic lymphoma; AML: acute myeloid leukemia; MM: multiple myeloma