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3525 T-allo10 Immunotherapy Results in Enhanced Early Immune Reconstitution and Reduced GvHD with Excellent Clinical Outcomes Post Αβ-Depleted HSCT in Pediatric and Young Adult Hematologic Malignancy Patients

Program: Oral and Poster Abstracts
Session: 722. Allogeneic Transplantation: Acute and Chronic GVHD and Immune Reconstitution: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical trials, Translational Research, Clinical Research
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Alice Bertaina, MD, PhD1,2,3, Rosa Bacchetta, MD1,2,3*, Alma-Martina Cepika, MD, PhD1,2*, David C Shyr, MD1,2,3, Giulia Barbarito, MS1,2*, Linda Oppizzi, BS1,2*, Pauline Chen, MD1,2*, Gopin Saini, MBBS1,2*, Jennifer Lee, PhD1,2*, Karen Kristovich, RN PNP1,3*, Rajni Agarwal, MD2,4,5*, Orly Klein, MD1,2,3, Kathryn Melsop, MS2,6*, Keri Tate, PhD2,6*, Matthew Porteus, MD, PhD1,2,3 and Maria Grazia Roncarolo, MD1,2,3

1Department of Pediatrics/ Division of Hematology, Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
2Center for Definitive and Curative Medicine, Stanford University School of Medicine, Stanford, CA
3Lucile Packard Children’s Hospital, Palo Alto, CA
4Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA
5Lucile Packard Children’s Hospital, Palo Alto
6Laboratory for Cell and Gene Medicine, Stanford University School of Medicine, Palo Alto, CA

We completed the first phase of a Phase Ia/Ib trial at Stanford Children’s Health involving T-allo10 cells. Fourteen pediatric and young adult patients with hematologic malignancies were enrolled (NCT 04640987), and 13/14 received T-allo10 infusion on Day 35 ±7 days post-TCRαβ+ T-cell and CD19+ B-cell-depleted (αβdepleted) HSCT. T-allo10 cells, generated from donor CD4+ T cells and enriched in host alloantigen-specific type 1 regulatory T (Tr1) cells, suppress host-reactive TCRαβ+ T cells causing acute (a)GvHD. They also contain polyclonal naive and memory TCRαβ+ T cells crucial for pathogen and tumor defense.

We hypothesized T-allo10 infusion post-αβdepleted-HSCT would expedite immune reconstitution (IR) by providing polyclonal TCRαβ+ T cells and modulate anti-host immune responses via Tr1 cells, aiming to enhance IR, reduce infections and leukemic relapse without severe GvHD. Achieving these goals would address αβdepleted-HSCT challenges like viral reactivations (~50%) and leukemic relapse (25-30%).

In the Phase Ia portion of this trial, T-allo10 cells were administered at three escalating doses (Cohort 1: 10^5/kg; Cohort 2: 3x10^5/kg; Cohort 3: 1x10^6/kg). No dose-limiting toxicities (DLTs) were observed. Across cohorts, the patients' ages ranged from 1.7 to 24 years (7 females, 6 males). Diagnoses included acute myeloid leukemia (AML, 4 patients), acute lymphoblastic leukemia (ALL, B-cell, 6 patients), myelodysplastic syndromes (MDS, 2 patients), and mixed phenotype acute leukemia (MPAL, 1 patient). Patients received peripheral blood stem cells (PBSC) with doses ranging from 8 to 35 x 10^6 CD34+ cells/kg and αβ+/CD3+ cells ranging from 0.04 to 0.63 x 10^5 cells/kg. Tr1 cells in T-allo10 ranged from 0.9% to 14.7%.

No cases of non-relapsed mortality (NRM) occurred, with 0% NRM at 6 months and 1 year, favorably compared to historical controls (9%). Relapse was observed in 2 patients (15.4%) in Cohort 1, at +307 and +90 days post-HSCT. No relapses were reported in Cohorts 2 and 3. Patients treated with intermediate and high doses of T-allo10 achieved 100% 2-year leukemia-free survival (LFS) and graft-versus-host disease-free relapse-free survival (GRFS).

Steroid-responsive grade II aGvHD developed in 4 patients (30.8%). No grade III-IV aGvHD was observed. Remarkably, 66.7% of evaluable patients (6/9) achieved the IR efficacy endpoint, doubling the historical control rate of 31%. This endpoint is defined as ≥50 CD3+CD4+ T cells/µL by Day +60 post-αβdepleted-HSCT.

T-allo10 infusion increased the frequency of TCRαβ+ CD3+CD4+ T cells with a memory phenotype in all patients. Incidence and severity of viral reactivations decreased with increasing dose of T-allo10 cells. Adenovirus reactivation decreased from 60% in Cohort 1 to 0% in Cohort 3, and BK virus reactivation was not observed in Cohorts 2 and 3 compared to 60% in Cohort 1. These results are paralleled by an increased in vitro response to viral antigens and mitogens at Day +180 post-HSCT, irrespective of infection status. Two-thirds of patients in Cohorts 2 and 3 responded positively to mitogens at six months, with viral antigen-specific responses comparable to the donor's baseline.

Tr1 cells were detectable in peripheral blood by flow cytometry shortly after T-allo10 infusion, peaking at 20.4% at day +7, then remained stable and within the normal range. Their persistence over time was confirmed by tracking the TCRα and TCRβ Tr1 cell clonotypes identified in each T-allo10 product.

These findings indicate that T-allo10 promotes phenotypic and functional IR without escalating GvHD risk. We are currently enrolling patients in the Phase Ib at dose levels of Cohorts 2 and 3 to define the optimal dose of T-allo10 cells.

In conclusion, Phase I trial results show that T-allo10 infusion is safe and significantly improves early IR and reduces GvHD risk in pediatric and young adult patients post-αβdepleted-HSCT. No NRM was observed at 6 months and 1 year. Cohorts 2 and 3 achieved 100% 2-year LFS and GRFS. Tr1 cells were detected shortly after infusion, reaching up to 20% within days 1-7, showing a dose-dependent trend. T-allo10 infusion enhanced CD4+ T-cell IR, particularly expanding CD4+ memory T cells. These findings support T-allo10 as a promising immunotherapy to enhance IR and improve survival outcomes, warranting farther investigation.

Disclosures: Bertaina: Miltenyi: Current Employment, Honoraria; Neovii: Current Employment, Honoraria; Gilead: Current Employment, Research Funding. Porteus: CRISPR Tx: Current equity holder in publicly-traded company; Allogene Tx: Current holder of stock options in a privately-held company, Membership on an entity's Board of Directors or advisory committees; Kamau Tx: Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees.

*signifies non-member of ASH