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
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.