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Expanded natural killer (ENK) cells are an investigational cell-based immunotherapy developed by the University of Arkansas for Medical Sciences (UAMS) Myeloma Institute for the treatment of high-risk multiple myeloma. These cells are generated by taking natural killer cells and expanding them ex vivo using K562 feeder cells modified to express membrane-bound interleukin-15 (IL-15) and the costimulatory molecule 4-1BBL. This process activates and significantly increases the number of NK cells to enhance their anti-tumor potency. The therapy is primarily evaluated in combination regimens, such as with the monoclonal antibody elotuzumab and the IL-15 superagonist ALT-803, following autologous stem cell transplantation (ASCT). The mechanism of action involves direct natural killer cell-mediated cytotoxicity against myeloma cells and antibody-dependent cellular cytotoxicity (ADCC) when used alongside targeting antibodies.
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