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184 Post-Allograft Romidepsin Maintenance Mitigates Relapse Risk and Stimulates the Graft-Versus-Malignancy Effect through Enhanced NK-Cell Cytotoxicity in Patients with T-Cell Malignancies: Final Results of a Phase I/II Trial

Program: Oral and Poster Abstracts
Type: Oral
Session: 624. Hodgkin Lymphomas and T/NK Cell Lymphomas: Clinical and Epidemiological: Topics in T Cell, Szary and Hodgkin Lymphomas
Hematology Disease Topics & Pathways:
Research, clinical trials, Lymphomas, Clinical Research, T Cell lymphoma, Diseases, Lymphoid Malignancies
Saturday, December 9, 2023: 2:45 PM

Chitra Hosing, MD1, Zachary Braunstein, MD2, Eric McLaughlin, MS3*, Benigno C. Valdez, PhD4, Borje S. Andersson, MD5, Uday R. Popat, MD1, Sumithira Vasu, MD, MBBS6, Evandro Bezzera, MD7*, Gabriela Sanchez-Petitto, MD6, Sarah A Wall, MD, MPH8, Samantha M. Jaglowski, MD, MPH9, Sam Penza, MD10, Hannah Choe, MD11, Lai Wei, PhD3*, Robin Nakkula12*, Alex Cash13*, Richard E. Champlin, MD1, Marcos de Lima, MD14*, Steven M. Devine, MD15, Dean Anthony Lee, MD, PhD16 and Jonathan E. Brammer, MD17

1Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
2The James Cancer Hospital at The Ohio State University Wexner Medical Center, Columbus, OH
3Center for Biostatistics, The Ohio State University, Columbus, OH
4The University of Texas M D Anderson Cancer Center, Houston, TX
5Department of Stem Cell Transplantation & Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston
6Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH
7Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH
8Division of Hematology, The Ohio State University, Columbus, OH
9Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
10Ohio State University, Columbus, OH
11Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
12Center for Childhood Cancer and Blood Diseases, Abigail Wexner Research Institute, The Research Institute at Nationwide Children’s Hospital, Columbus, OH
13Pediatric Hematology, Nationwide Children's Hospital, Columbus, OH
14James Comprehensive Cancer Center, The Ohio State University, Columbus, OH
15CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
16Center for Childhood Cancer, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
17The James Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH

Background: For patients with high risk, and relapsed/refractory T-cell malignancies allogeneic stem cell transplant (allo-SCT) is the only available potentially curative therapy. The efficacy of allo-SCT is limited in this population by high rates of relapse, with rates up to 55-60% post-allo-SCT. We designed a phase I/II trial, evaluating the combination of the histone deacetylases inhibitor romidepsin (rom) with busulfan/fludarabine (BuFlu) conditioning, followed by romidepsin maintenance (m-rom) in patients receiving allo-SCT for T-cell malignancies (NCT02512497). Here we present final clinical results of this therapeutic approach, including an evaluation of the stimulatory effects of m-rom on the graft-versus-malignancy effect through NK-cells post-allo-SCT.

Methods:
This was a phase I/II clinical trial. Eligible patients had: a diagnosis of T-cell leukemia (including T-acute lymphoblastic leukemia) or T-cell lymphoma (TCL, cutaneous or peripheral) in at least a partial remission requiring an allo-SCT, <70 years of age, with a matched sibling/unrelated donor. Patients received myeloablative (20K) or reduced intensity (16K) BuFlu with rom, followed by standard tacrolimus/methotrexate GVHD prophylaxis and anti-thymocyte globulin for unrelated donors (MUD). An expansion cohort of up to 30 patients (total) was included. M-rom was initiated between day +28 and +100 for 1 year (2nd year optional), with built in dose reductions for toxicity. An efficacy endpoint of 20% reduction in relapse risk at 1-year in the whole cohort or any individual disease cohort was set based upon historical/CIBMTR (Center for Blood and Marrow Transplant Research) controls was pre-specified. The effect of m-rom on NK-cell cytotoxicity was assessed on samples taken pre-transplant, and 1, 3, 6, 12 months post allo-SCT. NK cytotoxicity was assessed by isolating mononuclear cells from patient samples at each timepoint, comparing those on m-rom (n=13) versus those who did BuFlu controls who did not receive m-rom (n=16). Cells were targeted against K562 targets using the calcein-AM assay. K-M and Fine-Gray models were used to estimate PFS, OS, and cumulative incidence, and compare survival across groups.

Results:

28 patients were enrolled on this trial (Table). With a median follow-up time of 15 months, the median OS is 3.3 years (95% CI: 0.85-not reached), with a 1 and 3 year OS probability of 68% and 54%. The median PFS is 2.3 years (95% CI: 0.6-not reached), with 1 and 3-year PFS of 61% and 41%. Cumulative incidence (CI) of NRM at day 100 and 1 year were 14.3% and 21.4%. CI of grade II-IV aGHVD and extensive cGVHD were 46.4% and 38%. The CI of relapse (CIR) was 18.1% at 1 year and 33% at 3 -years. There was no difference between PFS among patients with MRD versus those without MRD prior to transplant (p=0.43).

The CIR of patients with TCL was 9.3% at 1 and 3 years, whereas the CIR of patients with leukemia was 25% at 1 year and 48% at 3 years. No patients with PTCL relapsed, 1/2 patients with CTCL relapsed, and 4/6 patients with T-PLL are alive, disease free. Pre-specified general CIR was 55% for all patients. With an overall CIR of 18% at 1 year, and 33% at 3-years, this trial met its pre-specified endpoint of decreasing relapse by 20% at 1-year, and performed well compared to published CIBMTR control populations. Matched propensity score analysis across disease subsets with CIBMTR controls will be presented.

18/28 (64%) of patients received m-rom with a median number of 13 cycles (range 1-47). 8 patients experienced grade 3/4 adverse events (AE), and 1 patient discontinued m-rom due to toxicity, unlikely related to romidepsin (loss of CD3 chimerism). When NK-cytotoxicity was assessed between the two groups after starting maintenance, NK-cytotoxicity in the m-rom group was significantly higher than in those without m-rom (p<0.0001) (Figure).

Conclusions:

BuFluRom with m-rom is effective at decreasing relapse in patients with T-cell malignancies, with 1-year CI relapse below expected relapse rates for this set of diseases, meeting the pre-specified efficacy endpoint. NK-cell cytotoxicity data in a large sample set of trial patients demonstrates that m-rom enhances NK-cell cytotoxicity post allo-SCT, augmenting the GVL effect and likely accounting for at a minimum, some of the decrease in relapse seen on this trial. M-rom should be considered a new option post allo-SCT to mitigate relapse in patients with T-cell malignancies.

Disclosures: Vasu: Omeros Inc: Research Funding; Sanofi Inc: Research Funding. Wall: Abbvie, BMS: Honoraria; CTI: Speakers Bureau. Jaglowski: Kite. a Gilead Company: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Takeda: Consultancy; CRISPR: Consultancy; Caribou: Research Funding. Choe: NIH National Cancer Institute: Research Funding; Actinium Pharmaceuticals: Other: Support for attending meetings and/or travel; MJH Life Sciences: Honoraria; Opna: Other: Receipt of equipment, materials, drugs to institution, Research Funding; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Receipt of equipment, materials, drugs to institution. Champlin: Takeda Corporation: Patents & Royalties; Cell Source: Research Funding; Johnson & Johnson/Janssen: Consultancy; Orca Bio: Consultancy; Omeros: Consultancy; Arog: Consultancy; Kadmon: Consultancy; Actinium Pharmaceuticals: Consultancy. de Lima: Pfizer: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Scribb: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Data Safety Monitoring Board; AbbVie: Other: Data Safety Monitoring Board; Miltenyi Biotec: Research Funding. Lee: Kiadis Pharma, a Sanofi Corporation: Consultancy, Patents & Royalties: licensed through Nationwide Children's Hospital; Avidicure B.V.: Consultancy, Current equity holder in private company, Research Funding. Brammer: Verastem: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Kymera: Consultancy; Incyte: Research Funding; Dren Bio: Consultancy; Bristol Myers Squibb: Research Funding.

OffLabel Disclosure: This off label use is part of a clinical trial.

*signifies non-member of ASH