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1031 Phase 2 Registrational Study of Anitocabtagene Autoleucel for the Treatment of Patients with Relapsed and/or Refractory Multiple Myeloma: Preliminary Results from the IMMagine-1 Trial

Program: Oral and Poster Abstracts
Type: Oral
Session: 655. Multiple Myeloma: Cellular Therapies: Unleashing Cell Therapies Against Myeloma
Hematology Disease Topics & Pathways:
Research, Clinical trials, Adult, Clinical Research, Plasma Cell Disorders, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Study Population, Human
Monday, December 9, 2024: 5:30 PM

Ciara Louise Freeman, PhD, MSc, FRCPC, MRCP1, Binod Dhakal, MBBS2, Gurbakhash Kaur, MD, MA3, Richard T. Maziarz, MD4, Natalie Callander, MD5, Adam S. Sperling, MD, PhD6, Carolina Schinke, MD7, Andrzej J Jakubowiak, MD, PhD8, Noa Biran, MD9, Douglas W Sborov, MD10, Cindy Varga, MD, BSc11, Abhinav Deol, MD12*, Abraham S. Kanate, MD13*, Mehmet Hakan Koçoğlu, MD14*, Melhem M. Solh, MD15, Kamalika Banerjee, MA16*, Rebecca Chan, MD, PhD16*, Myrna Nahas, MD17, Ana Kostic, MD16*, Enrique Granados, MD18*, Carolyn Jackson, MD, MPH17*, Christopher R. Heery, MD16, Tim Welliver, MD, PhD19*, Krina K. Patel, MD, MSc20 and Matthew Frigault, MD, MS21

1Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
2Medical College of Wisconsin, Milwaukee, WI
3Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
4Knight Cancer Institute, Oregon Health and Science University, Portland, OR
5University of Wisconsin, Carbone Cancer Center, Madison, WI
6Dana-Farber Cancer Institute, Boston, MA
7Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR
8Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL
9Division of Multiple Myeloma, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ
10Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
11Department of Hematologic Oncology and Blood Disorders, Atrium Health Levine Cancer Institute, Charlotte, NC
12Karmanos Cancer Institute, Detroit, MI
13HonorHealth Cancer Transplant Institute, Scottsdale, AZ
14University of Maryland School of Medicine, Baltimore, MD
15Northside Hospital, Atlanta, GA
16Arcellx, Inc., Redwood City, CA
17Kite, a Gilead Company, Santa Monica, CA
18Kite, A Gilead Company, Santa Monica, CA
19800 Bridge Parkway, Arcellx, Inc., Redwood City, CA
20Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX
21Massachusetts General Hospital Center, Dorchester, MA

Background: Anitocabtagene autoleucel (anito-cel, previously CART-ddBCMA) is an autologous anti–B-cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T-cell therapy with a novel D-domain binder under development for patients (pts) with relapsed and/or refractory multiple myeloma (RRMM). Results from the Phase 1 study in pts with RRMM who had ≥3 prior lines of therapy (LoT; 4L+; N=38) demonstrated an overall response rate (ORR) of 100%, a complete response (CR)/stringent CR (sCR) rate of 76%, and an estimated 24-month progression-free survival (PFS) rate of 56% (Frigault MJ, et al. ASH 2023). Initial results from the ongoing iMMagine-1 Phase 2 registrational trial (NCT05396885) are presented in this report.

Methods: Eligible triple-class–exposed pts ≥18 years with RRMM who progressed after ≥3 prior LoT with evidence of measurable disease, and were refractory to their last LoT, were enrolled. Following leukapheresis, optional bridging, and anito-cel manufacturing, pts received lymphodepletion chemotherapy (fludarabine 30 mg/m2/d and cyclophosphamide 300 mg/m2/d for 3 days) and a single infusion of anito-cel (target dose of 115×106 CAR+ viable T cells). The primary endpoint of the study is to determine the efficacy of anito-cel, assessed by ORR (sCR, CR, very good partial response [VGPR], and partial response [PR]), as determined by an independent review committee. Efficacy outcomes were assessed using 2016 International Myeloma Working Group (IMWG) criteria, minimal residual disease (MRD) was assessed by next-generation sequencing (sensitivity threshold, 10-5), toxicity was graded per Common Terminology Criteria for Adverse Events version 5.0, and cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were graded by the American Society for Transplantation and Cellular Therapy consensus criteria. This preliminary analysis of pts with ≥2 months of follow-up after anito-cel infusion reports investigator-assessed safety and efficacy outcomes.

Results: As of June 1, 2024, 58 pts had received anito-cel infusion under the final manufacturing process with ≥2 months of follow-up after infusion; median follow-up was 10.3 months (range, 2.0-17.8). Median age was 66 years (range, 38-77). Pts had received a median of 4 prior LoT (range, 3-8) with 26 pts (45%) having received only 3 prior LoT. Forty pts (69%) were triple-class refractory and 20 (34%) were penta-class refractory. Investigator-assessed ORR per IMWG criteria was 95% (55/58) with a CR/sCR rate of 62% (36/58). Of those evaluable for MRD testing (n=39), 36 (92%) achieved MRD negativity at least to the level of 10-5. The Kaplan–Meier-estimated 6-month PFS and overall survival (OS) rates (95% CI) were 90% (77-96) and 95% (85-98), respectively; median PFS and OS have not yet been reached.

Any grade (Gr) CRS was observed in 49 pts (84%). Notably, 46 pts (79%) had either no CRS (n=9, 16%) or Gr 1 CRS (n=37, 64%). Additionally, Gr 2 CRS events occurred in 11 pts (19%), and 1 pt (2%) had a Gr 5 CRS event. The median time to CRS onset was 2 days (range, 1-17) with a median duration of 3 days (range, 1-9). Of note, 31 pts (53%) had no fever or CRS in the first 3 days of anito-cel.

Any Gr ICANS was observed in 5 pts (9%): 2 (3%) Gr 1, 2 (3%) Gr 2, and 1 (2%) Gr 3 events. Median time to ICANS onset was 5 days (range, 2-7) with a median duration of 6 days (range, 1-10); all cases resolved without sequelae. No delayed neurotoxicity, cranial nerve palsies, Guillain Barre syndrome, or Parkinsonian-like symptoms were observed. Cytopenias were the most common Gr ≥3 treatment-emergent adverse events (AEs); 36 pts (62%) had Gr ≥3 neutropenia, 15 (26%) had Gr ≥3 thrombocytopenia, and 15 (26%) had Gr ≥3 anemia. Three deaths occurred due to AEs (both related and unrelated; retroperitoneal hemorrhage, CRS, fungal infection).

Conclusions: Preliminary results from the first 58 pts in the Phase 2 iMMagine-1 trial demonstrate deep and durable efficacy and manageable safety in a high-risk 4L+ RRMM population including triple- and penta-class refractory disease. Notably, no delayed neurotoxicity, cranial nerve palsies, Guillain Barre syndrome, or Parkinsonian-like symptoms were observed in the Phase 1 study or in the Phase 2 iMMagine-1 study to date. Updated data with additional follow-up will be presented.

Disclosures: Freeman: ONK therapeutics: Consultancy; Seattle Genetics: Consultancy; BMS: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Research Funding; Abbvie: Consultancy; Roche/Genentech: Research Funding; Amgen: Consultancy; Sanofi: Consultancy; Celgene: Consultancy; Incyte: Consultancy. Dhakal: Sanofi: Research Funding; Janssen: Honoraria, Research Funding, Speakers Bureau; Acrellx: Research Funding; Pfizer: Consultancy, Honoraria, Speakers Bureau; Carsgen: Research Funding; C4 therapeutics: Research Funding; Medical College of Wisconsin: Current Employment; Genentech: Consultancy, Honoraria; Karyopharm: Honoraria, Speakers Bureau; Bristol Myers Squibb: Honoraria, Research Funding. Kaur: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite, a Gilead Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Cellectar Biosciences: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Research Funding; Arcellx: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kedrion: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Honoraria. Maziarz: Athersys: Other: participated in data and safety monitoring boards, Patents & Royalties; Orca: Research Funding; Kite, a Gilead Company: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Novartis: Consultancy, Other: participated in data and safety monitoring boards , Research Funding; Ori-cell Therapeutic: Honoraria; Gilead Sciences: Other: stock or other ownership; Artiva Bio: Other: Leadership Role; stock or other ownership; Bristol Myers Squibb: Consultancy, Research Funding; CRISPR Therapeutics: Consultancy; Autolus: Consultancy; Vor BioPharma: Other: participated in data and safety monitoring boards; Century Therapeutics: Other: participated in data and safety monitoring boards. Sperling: Novartis: Consultancy. Schinke: Arcellx: Consultancy; Cancer Network: Honoraria; Janssen: Consultancy, Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; OncLive: Honoraria. Biran: AbbVie: Consultancy; Sanofi: Honoraria, Speakers Bureau; Amgen: Research Funding; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Karyopharm: Research Funding; Pfizer: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau. Sborov: Arcellx: Consultancy; Parexel, Keosys: Other: IRC; Pfizer: Consultancy, Research Funding; Abbvie: Consultancy; AstraZeneca: Consultancy; Bioline: Consultancy; Society of Utah Medical Oncology: Membership on an entity's Board of Directors or advisory committees; Genentech, Inc.: Consultancy; University of Utah, Huntsman Cancer Institute: Current Employment; Janssen: Consultancy; Legend Biotech: Consultancy; Bristol Myers Squibb: Consultancy; GlaxoSmithKline: Consultancy; Sanofi: Consultancy; Binaytara Foundation: Honoraria. Varga: Janssen: Consultancy, Research Funding; LavaTherapeutics: Research Funding. Deol: Kite, a Gilead Company: Consultancy; Adicet Biotherapeutics: Consultancy; Janssen: Consultancy. Kanate: IOVANCE: Other: stock or other ownership; Kite, a Gilead Company: Speakers Bureau; ADC Therapeutics: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Koçoğlu: GlaxoSmithKline: Other: research funding (to institution) from, Research Funding; Takeda: Other: research funding (to institution) from, Research Funding; Poseida: Other: research funding (to institution) from, Research Funding; Caelum: Other: research funding (to institution) from, Research Funding; Arcellx: Research Funding; Celgene/Bristol Myers Squibb: Other: research funding (to institution) from, Research Funding; Janssen: Other: research funding (to institution) from, Research Funding. Solh: Bristol Myers Squibb: Consultancy, Speakers Bureau; GlaxoSmithKline: Speakers Bureau; Sanofi: Consultancy. Banerjee: Arcellx: Current Employment, Other: stock ownership. Chan: Arcellx: Current Employment; Gilead Sciences: Other: stock or other ownership in. Nahas: Kite, a Gilead Company and Lantern: Current Employment, Other: stock or other ownership; Lantern: Other: immediate family member. Kostic: Arcellx: Current Employment, Other: stock ownership. Granados: Kite, A Gilead Company: Current Employment, Other: stock ownership. Jackson: Kite, a Gilead Company: Current Employment, Other: travel, accommodation and expenses; Johnson & Johnson (2018-2023): Ended employment in the past 24 months, Other: other intellectual property, and travel, accommodation and expenses , Patents & Royalties; Memorial Sloan Kettering Cancer Center: Consultancy, Other: Physician Consultant. Heery: Arcellx: Current Employment, Other: leadership role at, and stock or other ownership . Welliver: Arcellx: Current Employment, Other: stock or other ownership . Patel: Abbvie: Consultancy; Poseida: Consultancy; BMS: Consultancy, Other: chair of scientific advisory board ; Kite, A Gilead company: Consultancy, Other: scientific advisory board; Takeda: Consultancy; Merck: Consultancy; Johnson & Johnson (Janssen): Consultancy; Genentech: Consultancy; AstraZeneca: Consultancy; Pfizer: Consultancy; Sanofi: Consultancy; Caribou Sciences: Consultancy; Oricel: Consultancy, Other: Chair of scientific board. Frigault: Novartis: Consultancy; Kite, a Gilead Company: Consultancy; Bristol Meyers Squibb: Consultancy; JNJ/Legend: Consultancy; Cytoagents: Consultancy; Iovance: Consultancy; SOBI: Research Funding.

*signifies non-member of ASH