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
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.