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704.Cellular Immunotherapies: Early Phase and Investigational Therapies| November 15, 2022
Sara Ghorashian,
Sara Ghorashian
1Department of Hematology, Great Ormond Street Hospital for Children, London, United Kingdom
2Developmental Biology and Cancer, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Giovanna Lucchini,
Giovanna Lucchini *
3Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Rachel Richardson,
Rachel Richardson *
4Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Kyvi Nguyen,
Kyvi Nguyen *
5UCL Great Ormond Street Institute of Child Health, Molecular and Cellular Immunology, London, United Kingdom
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Craig Terris,
Craig Terris *
5UCL Great Ormond Street Institute of Child Health, Molecular and Cellular Immunology, London, United Kingdom
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Macarena Oporto-Espuelas,
Macarena Oporto-Espuelas *
5UCL Great Ormond Street Institute of Child Health, Molecular and Cellular Immunology, London, United Kingdom
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Jenny Yeung,
Jenny Yeung *
6UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Danielle Pinner,
Danielle Pinner *
3Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Jan Chu,
Jan Chu *
3Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Lindsey Williams,
Lindsey Williams *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Ka-yuk Ko,
Ka-yuk Ko *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Chloe Walding,
Chloe Walding *
8Cancer Clinical Trials Unit, University College London Hospitals NHS Trust, London, United Kingdom
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Kelly Watts,
Kelly Watts *
9Bone Marrow Transplantation, Royal Manchester Children's Hospital, Manchester, United Kingdom
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Sarah Inglott,
Sarah Inglott *
10Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Stuart Adams,
Stuart Adams *
11SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Emma Gravett,
Emma Gravett *
10Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Kimberly Gilmour,
Kimberly Gilmour *
12Department of Immunology, Great Ormond Street Hospital for Children, London, United Kingdom
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Alka Lal,
Alka Lal *
13CRUK Cancer Trials Centre, University College London, London, United Kingdom
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Sangeetha Kunaseelan,
Sangeetha Kunaseelan *
13CRUK Cancer Trials Centre, University College London, London, United Kingdom
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Bilyana Popova,
Bilyana Popova *
14CRUK UCL Cancer Trials Centre, UCL, London, United Kingdom
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Andre Lopes,
Andre Lopes *
15Cancer Research UK and UCL Cancer Trials Centre University College London, London, United Kingdom
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Yenting Ngai,
Yenting Ngai *
16UCL CRUK Cancer Trials Centre, University College London, London, United Kingdom
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Evangelia K Kokalaki,
Evangelia K Kokalaki *
17Autolus Ltd, London, United Kingdom
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Milena Balasch Carulla,
Milena Balasch Carulla *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Khushnuma Mullanfiroze,
Khushnuma Mullanfiroze *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Arina Lazareva,
Arina Lazareva *
3Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Vesna Pavasovic,
Vesna Pavasovic *
10Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Anupama Rao,
Anupama Rao *
10Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Jack Bartram,
Jack Bartram *
10Department of Haematology, Great Ormond Street Hospital for Children, London, United Kingdom
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Ajay Vora,
Ajay Vora
18Department of Haematology, The Children's Hospital, London, United Kingdom
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Robert Chiesa,
Robert Chiesa *
19Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Juliana Silva,
Juliana Silva *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Kanchan Rao,
Kanchan Rao *
3Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
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Katherine Clesham,
Katherine Clesham *
20Department of Haematology, University College London Hospitals NHS Trust, London, United Kingdom
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Denise Bonney,
Denise Bonney *
21Department of Bone Marrow Transplantation, Royal Manchester, Manchester, United Kingdom
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Robert F Wynn,
Robert F Wynn
22Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Martin Pule,
Martin Pule *
23Cancer Institute, University College London, London, United Kingdom
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Rachael E Hough,
Rachael E Hough *
24Haematology, UCLH, London, United Kingdom
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Persis J Amrolia
Persis J Amrolia *
7Bone Marrow Transplantation, Great Ormond Street Hospital for Children, London, United Kingdom
25UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Blood (2022) 140 (Supplement 1): 10352–10354.
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Citation
Sara Ghorashian, Giovanna Lucchini, Rachel Richardson, Kyvi Nguyen, Craig Terris, Macarena Oporto-Espuelas, Jenny Yeung, Danielle Pinner, Jan Chu, Lindsey Williams, Ka-yuk Ko, Chloe Walding, Kelly Watts, Sarah Inglott, Stuart Adams, Emma Gravett, Kimberly Gilmour, Alka Lal, Sangeetha Kunaseelan, Bilyana Popova, Andre Lopes, Yenting Ngai, Evangelia K Kokalaki, Milena Balasch Carulla, Khushnuma Mullanfiroze, Arina Lazareva, Vesna Pavasovic, Anupama Rao, Jack Bartram, Ajay Vora, Robert Chiesa, Juliana Silva, Kanchan Rao, Katherine Clesham, Denise Bonney, Robert F Wynn, Martin Pule, Rachael E Hough, Persis J Amrolia; Dual Antigen Targeting with Co-Transduced CD19/22 CAR T Cells May Prevent Antigen-Negative Relapse after CAR T Cell Therapy for Relapsed/Refractory ALL. Blood 2022; 140 (Supplement 1): 10352–10354. doi: https://doi.org/10.1182/blood-2022-164879
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Abstract
Background: CD19 negative escape is a major cause of relapse after CD19 CAR T cell therapy for relapsed/refractory (r/r) paediatric Acute Lymphoblastic Leukemia (ALL) and dual targeting of CD19/CD22 may overcome this. We have previously shown that AUTO1, a fast off rate autologous CD19 CAR T cell therapy was highly active in ALL with a favorable safety profile and excellent persistence (Ghorashian et al Nat.Med. 2019). Building on these properties, we developed AUTO1/22 an autologous CAR T cell product co-transduced with two different lentiviral vectors encoding our existing CD19 CAR and a novel CD22CAR designed to recognise targets with low antigen density. We have evaluated the safety and biological efficacy of AUTO1/22 in a Phase I study in children/young adults with r/r ALL (NCT02443831).
Methods: Patients with r/r B-ALL age < 25 yrs who were ineligible for/relapsed after Tisagenlecleucel were recruited. Following fludarabine/cyclophosphamide lymphodepletion, patients received 1x106 /kg CAR+ T cells. The presence of CAR T cells in the blood/bone marrow (BM) was assessed by flow cytometry + qPCR and BM MRD was assessed by IgH qPCR + flow cytometry. Primary endpoints were incidence of grade 3-5 toxicity and the proportion of patients achieving MRD negative remission.
Results: 12 patients have been treated. The median age was 12 years (range 3-21) and patients had a median of 3 prior lines of therapy (range 2-6). Six of 12 patients had relapsed post allogeneic SCT, 6 had received prior Blinatumomab/Inotuzumab and 4 had relapsed after prior Tisagenlecleucel. Prior to lymphodepletion, 4 patients had >5% BM disease by morphology/flow, 5 had detectable BM MRD and 3 were BM MRD negative. Six patients had extramedullary relapse (of which 2 had non-CNS EM disease). Three had detectable CD19 negative disease at enrolment. One of these was completely CD19 negative and in addition had a 5% CD22 negative population.
CAR T cell products had a central memory phenotype with predominance of CD19/22CAR double positive cells (median 54.4%) and balanced populations of CD19 and CD22 single positive cells (13.1% and 11.6% respectively).
Cytokine release syndrome (CRS) occurred in 11/12 patients (grade 1 n=5, grade 2 n=6) requiring Tocilizumab in 5 cases, but severe (≥ grade 3) CRS was not seen and no patients required ICU admission for CRS. Grade 1-2 ICANS was observed in 5 patients. One patient had delayed grade 4 leucoencephalopathy (MRI/brain biopsy were more indicative of fludarabine toxicity than CAR T related) and has ongoing neurological recovery. Nine patients had grade 3-4 cytopenia persisting beyond/recurring after day 28, requiring a CD34+ stem cell top up in 1 case.
Flow cytometry showed significant initial expansion of all 3 CAR +ve populations early post-infusion but CD19/22CAR double positive cells were lost at later time points. Six patients had circulating CAR T cells by qPCR at last follow up and the median duration of B cell aplasia has not been reached. Ten of 12 patients (83%) achieved MRD negative CR/CRi at one month post-infusion and 2 patients did not respond. Importantly 2/3 patients with CD19-ve disease achieved molecular CR demonstrating the efficacy of our CD22CAR. Of the 10 responding patients, 2 have relapsed with CD19+CD22+ disease, one patient with CD19-ve disease pre-infusion has relapsed with CD19partialCD22+ disease and one had emergence of MRD level disease, in all cases associated with loss of CAR T cells. One other patient had early loss of CAR T cells with B cell recovery but ongoing MRD negative CR at 3 months post-infusion and remains in MRD negative CR on maintenance chemotherapy. Overall, at a median follow-up of 8.7 months (range 1-15 months), 6/10 responding patients remain in MRD negative CR at last follow-up. Importantly, antigen-negative relapse has not been observed.
Summary/Conclusion: Our data show that dual CD19/22 targeting CAR T cells generated by co-transduction show a favorable safety profile, with robust expansion/persistence and early efficacy in a heavily pre-treated cohort.
To date with we have not observed antigen negative relapse. This contrasts to an incidence of 5/6 CD19 negative relapses in the 12 responders treated with single CD19 targeting CAR T cells (AUTO1) in an earlier cohort and suggests dual targeting may be effective in preventing antigen escape. However, longer follow up will be needed to confirm this.
Disclosures
Ghorashian:UCLB: Patents & Royalties; Novartis: Honoraria, Speakers Bureau. Yeung:Bristows LLP, 100 Victoria Embankment, London EC4Y 0DH: Consultancy; UCL Business: Patents & Royalties: WO2022064191A1 Named inventor; ADC Therapeutics: Patents & Royalties: WO2022063853A1 Named inventor; Quell Therapeutics: Consultancy. Kokalaki:Autolus Ltd: Current Employment. Pule:Autolus Ltd: Current Employment, Current equity holder in publicly-traded company. Amrolia:Bluebird Bio: Research Funding; Pierre Fabre: Consultancy; UCL Business: Patents & Royalties; Bluebird Bio: Research Funding; Pierre Fabre: Consultancy; Autolus: Patents & Royalties, Research Funding; ADC Therapeutics: Patents & Royalties: named inventor WO2022063853A1.
OffLabel Disclosure:
AUTO1/22 CAR T cells are being investigated and are not currently licensed for therapy of disease
Author notes
*
Asterisk with author names denotes non-ASH members.
© 2022 by The American Society of Hematology
2022
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November 15 2022
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