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CD137-ADC is an antibody-drug conjugate (ADC) consisting of a monoclonal antibody targeting CD137 (4-1BB) conjugated to α-amanitin, a potent transcription-inhibiting toxin. Developed for the prevention of acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (HCT), the drug leverages the transient expression of CD137 on activated, alloreactive T cells. By selectively delivering α-amanitin—which inhibits RNA polymerase II—to these cells, the ADC induces apoptosis in the T cells responsible for GVHD while sparing resting naïve and memory T-cell populations. This selectivity aims to prevent systemic toxicity and preserve the graft-versus-leukemia (GVL) effect. Preclinical studies in nonhuman primates have shown that a single dose administered at the time of transplant can effectively prevent aGVHD with rapid systemic clearance.
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