Monoclonal antibodies used for the management of hemataological disorders

ABSTRACT

Introduction

Monoclonal antibodies Ab (MoAb) are increasingly becoming part of therapeutic armamentarium for haematologists and haemato-oncologists. This review brings together commonly used antibodies in one place for brevity and novel understanding.

Areas Covered

Pubmed and Scopus databases were explored focusing on MoAb in clinical haematological practice. Emphasis was given to current review articles. The data base was searched from 1997 till present. 24 different antibodies, most of which are in use were discussed. Antibodies are used for diverse conditions i.e. malignant and benign haematological conditions, treatment at various phases of stem cell transplantation. These antibodies were used both alone or in combination with various chemotherapy, targeted small molecules or as immunoconjugates. Some of the side effect profiles of these antibodies were common and some were unique. Unusual infections or organ dysfunctions were noted. Improved function of antibodies by protein engineering is also advancing rapidly. Dosage, frequency and route of administration depended on the convenience and condition for which the antibody is used.

Expert Opinion

MoAbs are increasingly used in haematology practice either alone or in combination with other types of therapy for improved out come in various haematological conditions.

PLAIN LANGUAGE SUMMARY

Monoclonal antibodies are antibodies produced on an industrial scale in vitro. These are proteins that are directed against many macromolecules in our body which have a pathogenic role in causing different diseases. By producing these antibodies in a large amount on an industrial scale and modifying them for better action by molecular engineering, a large portfolio of therapeutic antibodies has been produced. A large number of monoclonal antibodies are used in hematological practice. Some familiarity with them and their usage are required for all hematologists even if it is outside their own day-to-day practice and expertise. Moreover, how modern biotechnology and antibody engineering technology are changing the facet of this therapy is also worthy of understanding. The present review encapsulates this area of advancing application and research.

KEYWORDS:

• Monoclonal antibody
• hematological disorders
• lymphoma
• leukemia
• MPN
• hemophilia
• PNH
• GVHD

Article Highlights

• MoAbs are used extensively in hematological disorders.

• These antibodies are at various levels of humanization to prevent immune reaction against these antibodies, which reduces its effectiveness and increase its side effects.

• These antibodies can be used alone or in combination with various other chemotherapy or targeted therapy.

• Antibody engineering produces various types of antibodies with different functional characteristics. Presently, this is a rapidly advancing field.

• Antibody drug conjugates are used extensively in malignant hematological disorders.

• MoAbs are now used for red cell, white cells, platelets, and coagulation disorders.

• Some MoAbs work upstream in the development of immunocompetent cells and prevent apoptosis of autoreactive clones leading to development of many autoantibodies some of them are directed toward cancer cells. These antibodies are used as broad spectrum immunotherapy for cancer including hematological and nonhematological cancer.

• Bifunctional antibodies can bring different antigens (proteins) closer together for intimate reaction and can improve cell-mediated immunity against cancer (Blinatumomab) or can also work like procoagulant molecules (Emicizumab).

• Some MoAbs after being used are terminated either because of lack of effectiveness compared existing therapy/side effects or maybe reintroduced later with different indications or dosages.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.