Type: Oral
Session: 637. Myelodysplastic Syndromes: Clinical and Epidemiological: Defining and Treating Chronic Myelomonocytic Leukemia
Hematology Disease Topics & Pathways:
Combination therapy, Chronic Myeloid Malignancies, CMML, Diseases, Treatment Considerations, Biological therapies, Myeloid Malignancies, Monoclonal Antibody Therapy
Methods: PREACH-M is a Phase 2/3 non-randomized, uncontrolled, open-label trial in 54 adults aged at least 18 years, newly diagnosed with WHO 2016 criteria for CMML stratified according to mutation status. Subjects exhibiting RAS-pathway mutations (NRAS, KRAS, CBL) receive 24 cycles (every 28 days) of AZA (SC; 75 mg/m2 for 7 days) and LENZ (IV; 552 mg; d1 & d15 of cycle 1 and d1 only for all subsequent cycles); while those with only TET2 mutations receive the same AZA regimen and sodium ascorbate (IV; 30 g for 7 days [15 g for 1st dose only, 30g thereafter if no evidence of tumor lysis syndrome]; PO; 1.1g on all other days). Subjects who complete 24 cycles of treatment are followed every 6 months for an additional 24 months. The primary endpoint is the frequency of complete response (CR) or partial response (PR) during the first 12 cycles according to Savona Criteria. Secondary endpoints include responses according to modified 2006 International Working Group criteria, 2 year overall survival, and symptom improvement. Interim analyses are planned when at least 33% (n=18) and 66% (n=36) patients have completed 12 months of treatment.
Results: As of August 1st 2024, 27 subjects were enrolled overall (18 receiving > 12 months of treatment) and 20 subjects were enrolled in the LENZ/AZA arm (9 females, 11 males with mean age 69; mean white cell count 37.8x109/L, mean Hb 108 g/L; mean platelet count, 72x109/L, mean blast count, 9%). Mutations included CBL (65% of subjects), NRAS (20%), KRAS (50%), ASXL1 (55%) and TET2 (70%). Subjects exhibited CPSS-MOL scores, of intermediate risk 1 (n=2), intermediate risk 2-3 (n=12), and high risk 4-6 (n=6). Overall, subjects had completed a median number of 13.5 cycles of LENZ/AZA at the time of reporting. 14 (70%) of subjects had not progressed, 2 went to allogeneic transplant and 4 (20%) had progressive disease. 85% of patients attained a complete remission (CR) or marrow complete remission (mCR) within the first 12 months on study, according to IWG 2006 criteria. According to Savona criteria, 85% of patients achieved a complete response or an optimal marrow response within the first 12 months on treatment. Importantly, 64% of patient achieving CR or marrow CR had detectable CBL mutations at baseline. Of the 10 subjects with dominant CBL mutations (VAF>10%), 90% achieved a CR or mCR in first 12 months with durable suppression of CBL clones. Of the 11 subjects with major clone KRAS/NRAS mutations (VAF>10%), 81% achieved a CR or mCR. Significantly, of all subjects who achieve CR or mCR at 3 months, 83% were still on study without progression at 12 months. Safety and tolerability for LENZ was excellent with no patients experiencing infusion related reactions. A total of nineteen grade 3 or 4 serious adverse events were reported, including anemia and febrile neutropenia, none of which were considered causally related to LENZ and six possibly related to azacitidine.
Conclusion: Interim analysis of the PREACH-M trial shows promising results with LENZ/AZA resulting in durable complete responses beyond 12 months with 85% of subjects achieving a complete remission or marrow complete remission without significant LENZ related toxicity. Significantly, 90% of patients with major clone CBL mutations achieved complete remission or marrow complete remission.
Disclosures: Hiwase: Abbvie: Honoraria; Astella Pharma: Honoraria; Otsuka: Honoraria. Ross: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Menarini: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria, Membership on an entity's Board of Directors or advisory committees; Keros: Membership on an entity's Board of Directors or advisory committees. Yeung: BMS: Research Funding; Novartis: Honoraria, Research Funding; Amgen: Honoraria; Takeda: Honoraria; Pfizer: Honoraria; Ascentage: Honoraria. Yong: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Honoraria, Research Funding; Celgene: Research Funding. Lane: Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GSK: Consultancy; BMS: Other: Drugs, Research Funding. Fong: Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees; Adaptive Biotech: Membership on an entity's Board of Directors or advisory committees; BeiGene: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Otsuka: Membership on an entity's Board of Directors or advisory committees; Jazz: Membership on an entity's Board of Directors or advisory committees; Novotech: Consultancy; Servier: Speakers Bureau; BMS: Speakers Bureau; Astella: Speakers Bureau. Hughes: Ariad: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Reynolds: Abbvie: Research Funding; Australasian Leukaemia and Lymphoma Group: Consultancy; Australasian Myeloma Research Consortium (AMaRC): Membership on an entity's Board of Directors or advisory committees; HaemaLogiX: Consultancy; Janssen: Research Funding; Monash University: Consultancy; MRFF: Membership on an entity's Board of Directors or advisory committees, Research Funding; NHMRC: Research Funding; Novartis AG: Other: Equity ownership; Novartis Australia: Honoraria; Sandoz AG: Other: Equity ownership; Telethon Kids Institute (Australia): Membership on an entity's Board of Directors or advisory committees.
OffLabel Disclosure: Lenzilumab is a humanized IgG1 monoclonal antibody that neutralises granulocyte-macrophage colony stimulating factor, a critical proliferative driver of chronic myelomonocytic leukemia