Efficacy of Chimeric Antigen Receptor Engineered Natural Killer Cells in the Treatment of Hematologic Malignancies: A Systematic Review and Meta-Analysis of Preclinical Studies

• Published in: Cytotherapy (Oxford, England) England), 2024-11
• Main Authors: Bastin, Donald J., Kilgour, Marisa K., Shorr, Risa, Sabri, Elham, Delluc, Aurélien, Ardolino, Michele, McComb, Scott, Lee, Seung-Hwan, Allan, David, Ramsay, Tim, Visram, Alissa
• Format: Article
• Language: English
• ISSN: 1465-3249
• DOI: 10.1016/j.jcyt.2024.11.004

Chimeric antigen receptor (CAR) engineered NK cells (CAR-NK) are a novel approach to the immunotherapy of hematologic malignancies which seeks to overcome some of the challenges faced by CAR-T cells (CAR-T). With few published clinical studies, preclinical studies can identify strategies to accelerate clinical translation. We conducted a systematic review on the preclinical in vivo use of CAR-NK for the treatment of hematologic malignancies to assess these therapies in a holistic and unbiased manner. Our protocol was registered with PROSPERO (ID: CRD42023438375). We performed a search of OVID MEDLINE, OVID Embase, and Embase for animal studies employing human CAR-NK cells in the treatment of hematologic malignancies. Screening of studies for eligibility criteria was performed in duplicate. Our primary outcomes were survival and reduction in tumor volume. Data extraction from individual experiments was performed by one reviewer using DigitizeitTM software and verified by a second reviewer. Meta-analysis and subgroup analyses were performed using Comprehensive Meta-AnalysisTM software. Information for descriptive outcomes was extracted in duplicate by two independent reviewers. Risk of bias was assessed using the SYRCLE Risk of Bias Tool for Animal Studies. A total of 34 papers met eligibility criteria. Overall, CD19 was the most common antigen targeted however there was substantial diversity in antigenic targets, source material for generating CAR-NK cells, and NK cell modifications. Mice treated with CAR-NK therapy survived significantly longer than untreated mice (median survival ratio of 1.18, 95% CI 1.10 – 1.27, p