Early B cell changes predict autoimmunity following combination immune checkpoint blockade.
Das, Rituparna 1; Bar, Noffar 1; Ferreira, Michelle 1,2; Newman, Aaron M. 3,4; Zhang, Lin 1; Bailur, Jithendra Kini 1; Bacchiocchi, Antonella 5; Kluger, Harriet 1; Wei, Wei 6; Halaban, Ruth 5; Sznol, Mario 1,7; Dhodapkar, Madhav V. 1,7,8; Dhodapkar, Kavita M. 2,7
[Miscellaneous Article] Journal of Clinical Investigation. 128(2):715-720, February 1, 2018.

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Combination checkpoint blockade (CCB) targeting inhibitory CTLA4 and PD1 receptors holds promise for cancer therapy. Immune-related adverse events (IRAEs) remain a major obstacle for the optimal application of CCB in cancer. Here, we analyzed B cell changes in patients with melanoma following treatment with either anti-CTLA4 or anti-PD1, or in combination. CCB therapy led to changes in circulating B cells that were detectable after the first cycle of therapy and characterized by a decline in circulating B cells and an increase in CD21lo B cells and plasmablasts. PD1 expression was higher in the CD21lo B cells, and B cell receptor sequencing of these cells demonstrated greater clonality and a higher frequency of clones compared with CD21hi cells. CCB induced proliferation in the CD21lo compartment, and single-cell RNA sequencing identified B cell activation in cells with genomic profiles of CD21lo B cells in vivo. Increased clonality of circulating B cells following CCB occurred in some patients. Treatment-induced changes in B cells preceded and correlated with both the frequency and timing of IRAEs. Patients with early B cell changes experienced higher rates of grade 3 or higher IRAEs 6 months after CCB. Thus, early changes in B cells following CCB may identify patients who are at increased risk of IRAEs, and preemptive strategies targeting B cells may reduce toxicities in these patients.

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