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4196 Sustained Remission and Decreased Severity of CAR T-Cell Related Adverse Events: An Updated Report on the Pivotal Study of Inaticabtagene Autoleucel (Inati-cel; CNCT19) Treatment in Adult Patients with Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia (r/r B-Cell ALL) in China

Program: Oral and Poster Abstracts
Session: 613. Acute Lymphoblastic Leukemias: Therapies Excluding Allogeneic Transplantation: Poster III
Hematology Disease Topics & Pathways:
Research, Clinical trials, Lymphoid Leukemias, ALL, Clinical Research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies
Monday, December 9, 2024, 6:00 PM-8:00 PM

Wang Ying, M.D.1,2*, Lulu Lv, PhD3*, Yongping Song4*, Xudong Wei, MD, PhD5*, Hongsheng Zhou, MD6*, Qifa Liu, MD6, Kailin Xu7*, Dongmei Yan7*, Cheng Zhang8*, Shuangyou Liu, phD9*, Jie Jin, M.D.10, Heng Mei11*, Ting Niu, MD, PhD12, Aibin Liang13*, Runxia Gu, MD1*, Chunmei Zheng3*, Yi Feng3*, Wenqiu Huang14*, Shuai Xin3*, Wei Jin3*, Lin Shi3*, Yongzeng Wang3* and Jianxiang Wang, MD1,2

1State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Tianjin, China
2Tianjin Institutes of Health Science, Tianjin, China
3Juventas Cell Therapy Ltd, Tianjin, China
4Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
5Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
6Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
7Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
8Army medical University affiliated Xinqiao Hospital, Chongqing, China
9Department of Hematology, Beijing Boren Hospital, Bejing, China
10Department of Hematology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
11Department of Haematology, Institute of Hematology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
12Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
13Department of Hematology, Tongji Hospital of Tongji University, Shanghai, China
14Juventas Cell Therapy Ltd, Beijing, China

Introduction: CAR-T cell therapies have shown promising efficacy in patients with relapsed or refractory B-cell malignancies. We have developed a unique autologous CD19-specific second-generation chimeric antigen receptor (CAR) T-cell product, Inaticabtagene autoleucel (Inati-cel; CNCT19), featuring a patent-protected CD19 scFv derived from clone HI19α (distinct from the commonly used FMC63) and a 4-1BB/CD3-ζ costimulatory domain. In November 2023, Inati-cel received approval in China for adult patients with r/r B-cell ALL. Previously, we have reported the results of a phase 2 clinical trial of administrating Inati-cel in patients with r/r B-cell ALL, Thirty-two of 39 (82.1%) patients achieved MRD-negative overall remission rate (ORR), comprising complete response (CR) and CR with incomplete hematological recovery (CRi), and a median duration of remission (DOR) and overall survival (OS) have not been reached (Ying Wang et al. ASH, 2022). Here, we provide updated efficacy and safety data for 48 patients. This trial was registered with Clinicaltrials.gov (NCT04684147).

Methods: Patients underwent leukapheresis to obtain T cells for Inati-cel manufacturing. Inati-cel was infused 2 to 14 days after lymphodepletion with cyclophosphamide and fludarabine. A single infusion of Inati-cel at a target dose of 0.5 × 108 (±20%) CAR T cells was administered. The primary endpoint was ORR at the end of Month 3 after Inati-cel infusion, assessed centrally. Other endpoints included minimal residual disease (MRD) negative rate, DOR, relapse-free survival (RFS), and OS.

Results: A total of 92 patients with r/r B-cell ALL was screened, and 67 patients were ultimately enrolled in the study. Forty-eight patients underwent lymphodepletion and received Inati-cel treatment. The median age of all treated patients was 32 years (range, 18-58years), with 54.2% being male. All patients were refractory (81.2%) or relapsed (18.8%) after multiple lines of prior therapy, with 72.9% having received 2 or more previous therapies, and 16.4% had previously received hematopoietic stem cell transplantation (HSCT). At screening, 77.1% of patients had more than 25% blasts in the bone marrow, and 60.4% had high-risk cytogenetic abnormalities including Ph+, TP53 deletion or mutation, MLL rearrangement, IKZF1 alteration, Ph-like, or E2A-PBX1 fusion gene.

Efficacy

As of the data cutoff date of 2 April 2024, with a median follow-up of 23.7 months (IQR, 6.2 – 23.7), 41 out of 48 patients (85.4%) achieved MRD-negative ORR after Inati-cel infusion, including 35 patients (72.9%) with CR and 6 (12.5%) with CRi. At the end of Month 3 post-infusion, 34 patients (70.8%) remained in CR (60.4%) or CRi (10.4%). The median DOR, both with and without censoring patients at subsequent allo-HSCT, was 20.7 months (95% CI, 6.4-not estimable with censoring, 9.5-not estimable without censoring). The median RFS was 12.4 months (95% CI, 5.2-not estimable). Median OS was not reached, with an estimated 2-year OS rate of 55.2% (95% CI, 38.2%, 69.3%). Sixteen patients survived more than 24 months, and the longest DOR exceeding 24 months without subsequent anti-cancer therapy, and persistently detectable Inati-cel in blood.

Safety

The most common adverse events (AEs) of special interest were cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Grade 3 or higher CRS and ICANS occurred in 12.5% and 6.2% of patients, respectively, with all patients recovering without sequelae. No deaths were attributed to CRS or ICANS

Conclusions: Inati-cel CAR-T cell therapy achieved a high MRD-negative ORR in adult patients with r/r B-cell ALL, with 85.4% of patients reaching CR/CRi post-infusion and demonstrating durable remission. The safety profile was favorable, with a low incidence of grade 3 or higher CRS and ICANS. With its distinct CAR structure containing a unique CD19 scFv (HI19a), Inati-cel provides effective treatment with potential long-term clinical benefits for adult patients with r/r B-cell ALL.

Disclosures: Jianxiang Wang, Advisor of Abbvie.

Disclosures: Wang: AbbVie: Membership on an entity's Board of Directors or advisory committees.

*signifies non-member of ASH