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3034 Clinical Outcomes of Patients with High-Risk Relapsed/Refractory Follicular Lymphoma Treated with Tisagenlecleucel: Phase 2 ELARA 4-Year Update

Program: Oral and Poster Abstracts
Session: 623. Mantle Cell, Follicular, Waldenstrom’s, and Other Indolent B Cell Lymphomas: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical trials, Lymphomas, Clinical Research, Diseases, Indolent lymphoma, Lymphoid Malignancies
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Catherine Thieblemont, MD1, Martin Dreyling, MD2, Michael J. Dickinson, MBBS, DMedSci3, Joaquín Martínez-Lopez4*, Arne Kolstad, MD, PhD5*, Jason Butler, MBBS6*, Monalisa Ghosh, MD7, Leslie L. Popplewell, MD, MPH8, Julio C. Chavez, MD9, Emmanuel Bachy, MD, PhD10, Koji Kato, MD, PhD11, Hideo Harigae, MD, PhD12, Marie José Kersten13*, Charalambos Andreadis, MD, MS14*, Peter A. Riedell, MD15*, Phoebe Joy Ho, MBBS16, Jose Antonio Pérez-Simón, MD, PhD17, Andy Chen, MD, PhD18, Loretta Nastoupil19*, Bastian von Tresckow20,21, Andrés José María Ferreri, MD22, Takanori Teshima, MD, PhD23, Piers E.M. Patten, MBChB, FRCP, FRCPath, PhD24*, Joseph P. McGuirk, DO25, Fritz Offner, MD, PhD26, Andreas Viardot, MD, PhD27, Pier Luigi Zinzani, MD, PhD28,29, Ram Malladi, MD, PhD30*, Aiesha Zia, MSc31*, Rakesh Awasthi, PhD32*, Davide Germano, PhD31*, Roberto Javier Ramos, MD32*, Pei Hsu, MD31*, Stephen J. Schuster, MD33 and Nathan H. Fowler, MD34*

1Service Hémato-Oncologie, Hôpital Saint- Louis, Paris, France
2Department of Medicine III, Ludwig Maximilian University Hospital, Munich, Germany
3Peter MacCallum Cancer Centre, Royal Melbourne Hospital and The University of Melbourne, Melbourne, VIC, Australia
4Hospital Universitario 12 de Octubre, CIBER-ONC CB16/12/00369, CNIO, Madrid, Spain
5Oslo University Hospital, Oslo, Norway
6Royal Brisbane Hospital, Herston, QLD, Australia
7Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
8Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Atlanta, GA
9Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
10Clinical Hematology, Hospices Civils de Lyon and Claude Bernard Lyon 1 University, Lyon, France
11Department of Hematology, Oncology, and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka Prefecture, Japan
12Department of Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
13Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
14Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
15David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
16Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
17Department of Hematology, University Hospital Virgen del Rocio-IBIS, Universidad de Sevilla, Sevilla, Spain
18Oregon Health and Science University, Portland, OR
19The University of Texas MD Anderson Cancer Center, Houston, TX
20Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
21University Hospital Essen, University of Duisburg-Essen, Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), Essen, Germany
22Unit of Lymphoid Malignancies, Department of Onco-Haematology, IRCCS San Raffaele Scientific Institute, Milano, Italy
23Department of Hematology, Hokkaido University, Sapporo, Japan
24King’s College London, London, United Kingdom
25University of Kansas Medical Center, Westwood, KS
26Universitair Ziekenhuis Gent, Gent, Belgium
27Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
28Universitaria di Bologna, Istituto Di Ematologia,, Bologna, Italy
29Institute of Hematology "Seràgnoli" University of Bologna, Bologna, Italy
30Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
31Novartis Pharma AG, Basel, Switzerland
32Novartis Pharmaceuticals, East Hanover, NJ
33Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
34BostonGene, Waltham, MA

Background: Treatment strategies for patients (pts) with relapsed/refractory follicular lymphoma (r/r FL) require consideration of prior therapies and pt-related factors to identify those who are likely to benefit from available treatment options. Tisagenlecleucel is a CAR-T cell therapy approved in the United States and Europe for adults with r/r FL after ≥2 lines of prior therapy. The primary analysis of the phase 2 ELARA trial reported high response rates and a favorable safety profile in pts with high-risk r/r FL. Here we report 4-year follow-up of efficacy, safety, and pharmacokinetics findings.

Methods: Eligible pts with r/r FL (grades 1-3A) previously treated with ≥2 lines of systemic therapy (including an anti-CD20 monoclonal antibody and alkylating agent) received a single tisagenlecleucel infusion (0.6-6×108 CAR+ viable T cells). Bridging therapy was permitted. Baseline clinical characteristics and circulating blood naive T cells were correlated with progression-free survival (PFS) and overall survival (OS). Cellular kinetics were determined by measurement of transgene levels by quantitative polymerase chain reaction. Minimal residual disease (MRD) levels were determined via clonoSEQ® Next Generation Sequencing assay performed at Adaptive Biotechnologies (Seattle, WA, USA): pre-infusion tissue samples were used for the clonotype identification; MRD tracking was performed in post-infusion plasma (ctDNA) samples.

Results: As of March 27, 2024, 97 pts were infused. Ninety-four pts were evaluable for efficacy with a median follow-up of 53 months (range: 46-62). At baseline, among efficacy-evaluable pts, key pt subgroups at high-risk were identified; 72.3% of pts had FL that was refractory to ≥2 prior regimens, 66.0% had bulky disease (>7 cm or 3 lesions >3 cm), 64.9% had progression of disease within 2 years of frontline systemic therapy (POD24), 60.6% had high Follicular Lymphoma International Prognostic Index (FLIPI; ≥3), and 21.3% had high tumor burden (total metabolic tumor volume >510 mL). Median PFS was 53.3 months (95% CI: 18.2-NE) by independent review committee (IRC) among all pts; 48-mo PFS was 50.2% in all pts and 66.1% in pts with a best overall response of complete response. Among identified pt subgroups at high risk, 48-mo PFS by IRC was 45.5% (POD24), 45.5% (high FLIPI), 45.2% (bulky disease), 52.8% (double refractory), and 23.2% (high tumor burden). Median OS was not reached; 48-mo OS was 79.3% in efficacy-evaluable pts. Among identified pt subgroups at high risk, 48-mo OS was 80.8% (POD24), 73.2% (high FLIPI), 73.0% (bulky disease), 83.7% (double refractory), and 65.5% (high tumor burden). MRD data were available on 32/97 pts (33.0%); 28/32 pts (87.5%) achieved MRD negativity at any time point. MRD-negative status was achieved in 82.8% (24/29) of evaluable pts at day 28, 77.8% (14/18) at month 3, 72.7% (16/22) at month 6, and 82.4% (14/17) at month 12, respectively. CAR transgene persistence (Tlast; time to last quantifiable transgene level) was observed for up to 1680 days; median Tlast was 210 days (range: 13-1680). No new safety signals have been reported since the last data cut. Second primary malignancies (defined as any new cancer occurring post infusion regardless of tisagenlecleucel relationship) were reported in 6 (6.2%) pts and included basal cell carcinoma (n=2), squamous cell carcinoma (n=2), acute myeloid leukemia (n=1), bladder transitional cell carcinoma (n=1), Bowen’s disease (n=1), malignant melanoma (n=1), metastatic squamous cell carcinoma (n=1), and myelodysplastic syndrome (n=1). As of the data cutoff, 19 pts have died during the study: 8 due to progressive disease, 10 due to AEs (1 pt each; acute myeloid leukemia, bladder transitional cell carcinoma, cardiac arrest, CRS, encephalitis, gastrointestinal hemorrhage, infection, metastatic squamous cell carcinoma, pneumonia, sepsis), and 1 from euthanasia.

Conclusions: Updated long-term follow-up from the ELARA trial continues to demonstrate robust durable responses >4 years post infusion, alongside a favorable safety profile. Correlative analyses suggest that most baseline high-risk disease characteristics (double-refractory disease, bulky disease, POD24, and high FLIPI) are not associated with inferior efficacy following tisagenlecleucel infusion in pts with r/r FL. Furthermore, high frequencies of MRD-negative status were achieved in a subset of evaluable pts.

Disclosures: Thieblemont: AstraZeneca: Honoraria; ADC Therapeutics: Honoraria; Incyte Corporation: Consultancy, Honoraria, Speakers Bureau; Sanofi: Honoraria; Novartis: Consultancy, Honoraria, Other: Travel and accommodation, Speakers Bureau; Cellectis: Honoraria; Janssen: Consultancy, Honoraria, Other: Travel and accommodation, Research Funding, Speakers Bureau; Bayer: Consultancy, Honoraria, Other: Travel and accommodation, Speakers Bureau; Roche: Consultancy, Honoraria, Other: Travel and accommodation, Research Funding, Speakers Bureau; BeiGene: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria, Other: Travel and accommodations, Research Funding, Speakers Bureau; Bristol Myers Squibb/Celgene: Consultancy, Honoraria, Other: Travel and accommodation, Speakers Bureau; Takeda: Consultancy, Honoraria, Other: Travel and Accommodation, Speakers Bureau; Kite/Gilead: Consultancy, Honoraria, Other: Travel and accommodation, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Other: Travel and accommodation, Speakers Bureau; University of Paris: Current Employment, Ended employment in the past 24 months; Regeneron: Consultancy, Honoraria. Dreyling: AbbVie, Bayer, BMS/Celgene, Gilead/Kite, Janssen, Lilly, F. Hoffmann-La Roche Ltd.: Research Funding; AstraZeneca, Beigene, Gilead/Kite, Janssen, Lilly, Novartis, F. Hoffmann-La Roche Ltd.: Honoraria; AbbVie, AstraZeneca, Beigene, BMS/Celgene, Gilead/Kite, Janssen, Lilly/Loxo, Novartis, F. Hoffmann-La Roche Ltd.: Membership on an entity's Board of Directors or advisory committees. Dickinson: Kite: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Gilead: Consultancy, Honoraria, Speakers Bureau; Adicet Bio: Consultancy, Honoraria; Genmab: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Speakers Bureau. Martínez-Lopez: Amgen: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Kite: Consultancy, Honoraria; Incity: Research Funding. Ghosh: Novartis: Research Funding; Cargo: Consultancy; Kite/Gilead: Research Funding; BMS: Consultancy; Cabaletta Bio: Consultancy, Research Funding. Popplewell: Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; SeaGen: Consultancy, Honoraria; Hoffmann–La Roche: Consultancy, Honoraria. Chavez: Merck: Research Funding; AstraZeneca: Consultancy; Lilly: Honoraria, Speakers Bureau; Janssen: Honoraria; Abbvie: Consultancy; GenMab: Consultancy, Research Funding; Cellectis: Consultancy; Allogene: Consultancy; BeiGene: Consultancy, Honoraria, Speakers Bureau; ADC Therapeutics: Consultancy; Novartis: Consultancy; Kite, a Gilead Company: Consultancy. Bachy: Amgen: Research Funding; AbbVie, Roche, Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BeiGene: Honoraria, Membership on an entity's Board of Directors or advisory committees; ADC Therapeutics: Honoraria; Novartis: Honoraria, Other: Personal Fees; Bristol Myers Squibb: Honoraria, Other: Personal Fees, Research Funding; Janssen: Consultancy, Honoraria; Incyte: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Other: Personal Fees; Kite, a Gilead Company: Consultancy, Honoraria, Other: Personal Fees. Harigae: Sumitomo Corporation: Research Funding; Kyowa Kirin: Research Funding; AbbVie Inc.: Honoraria; Novartis International AG: Honoraria; CHUGAI PHARMACEUTICAL CO.,LTD.: Honoraria, Research Funding; Sanofi: Honoraria. Kersten: Miltenyi Biotec: Consultancy, Honoraria; Kite, a Gilead company: Consultancy, Honoraria, Research Funding; Takeda: Research Funding; Roche: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria; BMS/Celgene: Consultancy, Honoraria, Research Funding. Andreadis: Novartis: Research Funding; Astra Zeneca: Consultancy; Gilead/Kite: Consultancy; Merck: Research Funding; Genmab: Research Funding; Abbvie: Consultancy; Roche: Research Funding; BMS: Consultancy; Seattle Genetics: Consultancy. Riedell: Genmab: Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Honoraria; Tessa Therapeutics: Research Funding; Cargo Therapeutics: Research Funding; Calibr: Research Funding; CRISPR Therapeutics: Research Funding; Xencor: Research Funding; Fate Therapeutics: Research Funding; Cellectis: Research Funding; Kite/Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy; Janssen: Consultancy; CVS Caremark: Consultancy; NektarTherapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sana Biotechnology: Consultancy; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech/Roche: Consultancy, Research Funding; BeiGene: Consultancy, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Intellia Therapeutics: Membership on an entity's Board of Directors or advisory committees. Ho: Novartis: Other: Research support on medical writing. Pérez-Simón: Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Jazz: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alexion: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; J&J: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; MSD: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Chen: Elsevier: Consultancy; ADC Therapeutics: Consultancy; Kite: Research Funding; Fate Therapeutics: Research Funding; BMS: Research Funding; Novartis: Research Funding. Nastoupil: Caribou Biosciences: Honoraria, Research Funding; Denovo Biopharma: Honoraria; Daiichi Sankyo: Honoraria, Research Funding; Genentech: Honoraria, Research Funding; BMS: Honoraria, Research Funding; AbbVie: Honoraria; ADC Therapeutics: Honoraria; Genmab: Honoraria, Research Funding; Gilead Sciences/Kite Pharma: Honoraria, Research Funding; Incyte Corporation: Honoraria; Janssen: Honoraria, Research Funding; Merck: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Regeneron: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Research Funding; Abbvie, BMS, Caribou Biosciences, Genentech, Genmab, Gilead/Kite, Janssen, Incyte, Ipsen, Merck, Novartis, Regeneron, Takeda: Consultancy; BMS, Caribou Biosciences, Daiichi Sankyo, Genentech, Genmab, Gilead/Kite, Janssen, Incyte, Ipsen, Merck, Novartis, Takeda: Research Funding; Abbvie, BMS, Caribou Biosciences, Daiichi Sankyo, Genentech, Genmab, Gilead/Kite, Janssen, Incyte, Ipsen, Novartis, Takeda: Honoraria. von Tresckow: AbbVie, AstraZeneca, Gilead Kite, Janssen-Cilag, Lilly, Merck Sharp & Dohme, Pierre Fabre, Roche, Takeda, and Novartis: Other: Travel and congress support ; Esteve (Inst), Merck Sharp & Dohme (Inst), Novartis (Inst), and Takeda (Inst): Research Funding; AbbVie, AstraZeneca, BMS/Celgene, Gilead Kite, Incyte, Janssen-Cilag, Lilly, Merck Sharp & Dohme, Novartis, Roche and Takeda: Honoraria; Allogene, Amgen, BMS/Celgene, Cerus, Gilead Kite, Incyte, IQVIA, Janssen-Cilag, Lilly, Merck Sharp & Dohme, Miltenyi, Novartis, Noscendo, Pentixapharm, Pfizer, Pierre Fabre, Qualworld, Regeneron, Roche, Sobi and Takeda: Consultancy. Teshima: Meiji Seika Pharma: Consultancy, Honoraria; Chugai: Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Kyowa-Kirin: Consultancy, Honoraria, Research Funding; Sumitomo Pharma: Research Funding; Gilead: Honoraria; Janssen: Honoraria; Eisai: Research Funding; Shionogi: Honoraria, Research Funding; Otsuka: Honoraria, Research Funding; LUCA Science: Research Funding; Symbio: Honoraria; Daiichi Sankyo: Honoraria, Research Funding; Nippon Shinyaku: Consultancy, Honoraria; Genmab: Honoraria; Abbvie: Honoraria; Asahi Kasei Pharma: Honoraria, Research Funding; Roche Diagnostics: Consultancy; Novartis: Honoraria; Astellas: Honoraria, Research Funding; AstraZeneca: Honoraria; Pfizer: Honoraria; Pharma Essentia Japan: Research Funding; Bristol-Myers Squibb: Honoraria; Nippon Kayaku: Honoraria, Research Funding; JCR Pharma: Honoraria, Research Funding; Fuji Pharma: Honoraria, Research Funding; Sanofi: Honoraria; MSD: Honoraria. Patten: AstraZeneca: Honoraria, Research Funding; AbbVie: Honoraria, Other: Travel, accommodations, expenses, Research Funding; BeiGene: Honoraria, Other: Travel, accommodations, expenses, Research Funding; Janssen: Honoraria, Other: Travel, accommodations, expenses, Research Funding; Novartis: Research Funding. McGuirk: NEKTAR therapeutics: Consultancy; Sana technologies: Consultancy; Caribou bio: Consultancy; CRISPR therapeutics: Consultancy; Autolus: Consultancy; Envision: Consultancy; Allo Vir: Consultancy; Novartis: Consultancy; Kite: Consultancy; BMS: Consultancy; Legend biotech: Consultancy. Viardot: AbbVie, Amgen, Kite, Roche, Astra Zeneca: Membership on an entity's Board of Directors or advisory committees; AbbVie, BMS, Kite, Novartis, Roche, Sobi: Honoraria. Zinzani: Secura Bio, Sandoz, ADC Therapeutics: Consultancy; Celltrion, Gilead, Janssen-Cilag, BMS, Servier, MSD, AstraZeneca, Takeda, Roche, EUSA Pharma, Kyowa Kirin, Novartis, Incyte, Beigene: Consultancy, Speakers Bureau. Zia: Novartis: Current Employment, Current equity holder in publicly-traded company. Awasthi: Novartis: Current Employment, Current equity holder in publicly-traded company. Germano: Novartis: Current Employment, Current equity holder in publicly-traded company. Ramos: Novartis: Current Employment, Current equity holder in publicly-traded company. Hsu: Novartis: Current Employment, Current equity holder in publicly-traded company. Fowler: Novartis: Consultancy; Bayer: Consultancy; TG Therapeutics: Consultancy; Roche/Genentech: Consultancy, Research Funding; BostonGene: Current Employment, Current equity holder in private company, Current holder of stock options in a privately-held company; CelGene: Consultancy; Verastem: Consultancy.

*signifies non-member of ASH