Abstract
Background: LBCLs are prevalent and aggressive subtypes of NHL, with limited treatment options and historically poor outcomes in the third- or later-line setting. Liso-cel is an autologous, CD19-directed, defined composition, 4-1BB CAR T cell product administered at equal target doses of CD8 + and CD4 + CAR + T cells. TRANSCEND NHL 001 (NCT02631044) is a seamless design, pivotal, phase 1 study evaluating liso-cel in patients (pts) with R/R LBCLs (Abramson et al. Lancet 2020). We present 2-year follow-up data from the LBCL cohort.
Methods: Pts ≥ 18 years of age with R/R DLBCL not otherwise specified (NOS, including de novo and transformed from any indolent lymphoma), high-grade B-cell lymphoma (HGBCL) with MYC and BCL2 and/or BCL6 rearrangements, primary mediastinal B-cell lymphoma (PMBCL), or follicular lymphoma grade 3B (FL3B) after ≥ 2 lines of therapy and with ECOG PS 0-2 were eligible. Pts with grade 3 or 4 cytopenias, mild to moderate organ dysfunction, and secondary CNS lymphoma were allowed. Bridging therapy was allowed at clinician discretion but reconfirmation of PET-positive disease was required before lymphodepletion with fludarabine and cyclophosphamide. Primary endpoints were treatment-emergent AEs (TEAE) and ORR. Key secondary endpoints were CR rate, duration of response (DOR), PFS, and OS. TEAEs, including investigator-identified neurological events (NE) related to liso-cel, were graded using NCI CTCAE v4.03; cytokine release syndrome (CRS) was graded per Lee 2014 criteria in the liso-cel-treated set (all pts who received ≥ 1 dose of liso-cel). ORR was assessed by an independent review committee (IRC) per Lugano 2014 criteria in the efficacy-evaluable set (all pts with confirmed PET-positive disease who received ≥ 1 dose of liso-cel). Pts were followed for 2 years after the last dose of liso-cel and were then asked to enroll in a separate long-term follow-up study for up to 15 years (NCT03435796).
Results: A total of 345 pts underwent leukapheresis. In the liso-cel-treated set (N = 270), median age was 63 years (range, 18-86); 41% of pts were ≥ 65 years of age. Histologies included DLBCL NOS (de novo, 51%; transformed from indolent lymphoma, 29%), HGBCL (13%), PMBCL (6%), and FL3B (1%). Seven pts (3%) had secondary CNS lymphoma. Pts received a median of 3 prior lines of systemic therapy (range, 1-8) and 33% had prior autologous HSCT (prior allogeneic HSCT, 3%). Of all pts, 67% were chemotherapy refractory, 45% had never achieved CR, and 59% received bridging therapy. As of the Jan 4, 2021 data cut, study is ongoing; 268 pts had ≥ 24 months (mo) of follow-up, died, or withdrew from the study. Responses per IRC (ORR, 73%; CR rate, 53%) in the efficacy-evaluable set (N = 257) were durable with a median (95% CI) DOR of 23.1 mo (8.6-not reached), median PFS of 6.8 mo (3.3-12.7), and median OS of 27.3 mo (16.2-45.6) (Table). At 24 mo, the probabilities (95% CI) of continued response, PFS, and OS were 49.5% (41.4%-57.0%), 40.6% (34.0%-47.2%), and 50.5% (44.1%-56.5%), respectively. During the 90-day treatment-emergent (TE) reporting period, 79% of pts in the liso-cel-treated set (N = 270) had grade ≥ 3 TEAEs; 45% had serious TEAEs. CRS and NE of any grade occurred in 42% and 30% of pts, respectively (grade 3-4 CRS, 2%; grade 3-4 NE, 10%). Median (range) time to onset of CRS and NE was 5 (1-14) and 9 (1-66) days, respectively. Grade ≥ 3 infections and laboratory-based prolonged cytopenia at Day 29 occurred in 12% and 37% of pts, respectively. In the post-TE (Day 91 to end of study) reporting period, which included 17 pts who received liso-cel re-treatment, 23% of pts in the liso-cel-treated set (N = 249) had grade ≥ 3 AEs and 17% had serious AEs. The most common grade ≥ 3 AEs in the post-TE period were neutropenia (7%), anemia (6%), thrombocytopenia (4%), and febrile neutropenia (4%). Grade ≥ 3 infections occurred in 5% of pts. In the post-TE period, 100 pts (37% of all pts) died, mostly due to disease progression (86% of all post-TE deaths; 32% of all pts). CAR T cells were present in peripheral blood for up to 4 years.
Conclusions: Liso-cel demonstrated durable remissions with estimated 2-year DOR and PFS rates of 49.5% and 40.6%, respectively, and a favorable safety profile in the extended follow-up analysis of this large CAR T cell study in R/R LBCLs. Most CAR T cell-associated AEs occurred within the initial 90-day TE reporting period. No new safety signals were observed during long-term follow-up.
Abramson: Genmab: Consultancy; Kite Pharma: Consultancy; C4 Therapeutics: Consultancy; Bristol-Myers Squibb Company: Consultancy, Research Funding; Kymera: Consultancy; Bluebird Bio: Consultancy; EMD Serono: Consultancy; Novartis: Consultancy; Morphosys: Consultancy; BeiGene: Consultancy; Allogene Therapeutics: Consultancy; Astra-Zeneca: Consultancy; Incyte Corporation: Consultancy; Seagen Inc.: Research Funding; AbbVie: Consultancy; Karyopharm: Consultancy; Genentech: Consultancy. Palomba: Rheos: Honoraria; Novartis: Consultancy; Lygenesis: Honoraria; Priothera: Honoraria; Juno: Patents & Royalties; Notch: Honoraria, Other: Stock; Pluto: Honoraria; Seres: Honoraria, Other: Stock, Patents & Royalties, Research Funding; Magenta: Honoraria; WindMIL: Honoraria; Kite: Consultancy; Ceramedix: Honoraria; Nektar: Honoraria; Wolters Kluwer: Patents & Royalties; PCYC: Consultancy; BeiGene: Consultancy. Gordon: Zylem Biosciences: Patents & Royalties: Patents, No royalties; Bristol Myers Squibb: Honoraria, Research Funding. Lunning: Myeloid Therapeutics: Consultancy; Spectrum: Consultancy; TG Therapeutics: Consultancy; AbbVie: Consultancy; Morphosys: Consultancy; Karyopharm: Consultancy; Beigene: Consultancy; Daiichi-Sankyo: Consultancy; Novartis: Consultancy; Kyowa Kirin: Consultancy; Legend: Consultancy; Janssen: Consultancy; ADC Therapeutics: Consultancy; Acrotech: Consultancy; Verastem: Consultancy; Celgene, a Bristol Myers Squibb Co.: Consultancy; AstraZeneca: Consultancy; Kite, a Gilead Company: Consultancy. Wang: Molecular Templates: Research Funding; BGICS: Honoraria; Miltenyi Biomedicine GmbH: Consultancy, Honoraria; Oncternal: Consultancy, Research Funding; Bayer Healthcare: Consultancy; Physicians Education Resources (PER): Honoraria; InnoCare: Consultancy, Research Funding; CAHON: Honoraria; OMI: Honoraria; Loxo Oncology: Consultancy, Research Funding; The First Afflicted Hospital of Zhejiang University: Honoraria; Lilly: Research Funding; Scripps: Honoraria; AstraZeneca: Consultancy, Honoraria, Research Funding; Clinical Care Options: Honoraria; Celgene: Research Funding; Imedex: Honoraria; Pharmacyclics: Consultancy, Research Funding; Chinese Medical Association: Honoraria; Mumbai Hematology Group: Honoraria; Dava Oncology: Honoraria; Moffit Cancer Center: Honoraria; Epizyme: Consultancy, Honoraria; DTRM Biopharma (Cayman) Limited: Consultancy; Genentech: Consultancy; CStone: Consultancy; Kite Pharma: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Anticancer Association: Honoraria; BeiGene: Consultancy, Honoraria, Research Funding; Hebei Cancer Prevention Federation: Honoraria; Newbridge Pharmaceuticals: Honoraria; Juno: Consultancy, Research Funding; BioInvent: Research Funding; VelosBio: Consultancy, Research Funding; Acerta Pharma: Consultancy, Honoraria, Research Funding. Arnason: Juno/BMS: Honoraria. Maloney: Janssen: Honoraria; MorphoSys: Honoraria; Novartis: Honoraria; Celgene: Honoraria, Other: Rights to royalties from Fred Hutchinson Cancer Research Center for patents licensed to Juno Therapeutics/Bristol Myers Squibb; BMS: Honoraria, Other: Rights to royalties from Fred Hutchinson Cancer Research Center for patents licensed to Juno Therapeutics/Bristol Myers Squibb; Amgen: Honoraria; Celgene: Other: Research funding was paid to my institution, Research Funding; Juno therapeutics: Other: Research funding was paid to my institution, Research Funding; Kite Pharma: Honoraria, Other: Research funding was paid to my institution, Research Funding; Navan Technologies: Honoraria, Other: Stock options; A2 Biotherapeutics: Honoraria, Other: Stock options; Umoja: Honoraria; Genentech: Honoraria; Legend Biotech: Honoraria; Juno Therapeutics: Honoraria, Other: Rights to royalties from Fred Hutchinson Cancer Research Center for patents licensed to Juno Therapeutics/Bristol Myers Squibb. Andreadis: Merck: Research Funding; BMS: Research Funding; CRISPR Therapeutics: Research Funding; GenMAB: Research Funding; Novartis: Research Funding; Roche: Current equity holder in publicly-traded company, Ended employment in the past 24 months; Epizyme: Honoraria; Incyte: Honoraria; TG Therapeutics: Honoraria; Kite: Honoraria; Karyopharm: Honoraria; Atara: Consultancy, Honoraria. Sehgal: Juno/Celgene: Research Funding; Kite/Gilead: Research Funding. Ghosh: Bristol Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau; Genentech: Research Funding; Karyopharma: Consultancy, Honoraria; Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding, Speakers Bureau; Genmab: Consultancy, Honoraria; Epizyme: Honoraria, Speakers Bureau; Seattle Genetics: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Incyte: Consultancy, Honoraria; TG Therapeutics: Consultancy, Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria, Speakers Bureau; ADC Therapeutics: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding, Speakers Bureau; Adaptive Biotech: Consultancy, Honoraria; AbbVie: Honoraria, Speakers Bureau. Kostic: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Kim: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Ogasawara: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Dehner: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Siddiqi: BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Juno Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics LLC, an AbbVie Company: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; TG Therapeutics: Research Funding; Kite Pharma: Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BeiGene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Speakers Bureau; Oncternal: Research Funding.
