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367 Targeting Lymphoma Associated Myeloid-Monocytic Cells through CSF1R Blockade Enhances CAR-T Cell Response in Aggressive B Cell Lymphoma

Program: Oral and Poster Abstracts
Type: Oral
Session: 702. CAR-T Cell Therapies: Basic and Translational: Myeloid Biology and CAR-T Cells
Hematology Disease Topics & Pathways:
Combination therapy, Research, Adult, Lymphomas, Translational Research, B Cell lymphoma, Diseases, Treatment Considerations, Aggressive lymphoma, Lymphoid Malignancies, Study Population, Human, Animal model
Saturday, December 7, 2024: 4:00 PM

David Stahl, MD1*, Philipp Gödel, MD1*, Hyatt Balke-Want, MD1*, Paul Segbers1*, Luis Tetenborg1*, Rahil Gholamipoorfard, PhD2*, Daniel Bachurski, MD1*, France Rose, PhD3*, Zinaida Good, PhD4, Adrian G. Simon, MD5*, Marieke Nill1*, Ruth Flümann, MD1*, Tobias Riet, PhD1*, Janina Dörr, PhD6*, Stuart J. Blakemore, PhD1*, Herrad Baurmann, MD7*, Conrad-Amadeus Voltin, MD8*, Nicole Potter9*, Lilli Schlözer1*, Svenja Wagener-Ryczek5*, Andra-Iza Iuga, MD10*, Jan-Michel Heger, MD1*, Hanna Ludwig, MD1*, Julia K. Schleifenbaum, MD1*, Paul J. Bröckelmann, MD1*, Ron D. Jachimowicz, MD1*, Gero Knittel, PhD11*, Sven Borchmann, MD/PhD1*, Sabine Merkelbach-Bruse, PhD5*, Christian Pallasch, MD1*, Martin Peifer, PhD2*, Mark Nitz, PhD9*, Johannes Brägelmann, MD2*, Werner Müller, PhD7*, Thorsten Persigehl, MD10*, Katarzyna Bozek, PhD3*, Reinhard Büttner, MD5*, Michael J. Hallek, MD1, Sebastian Kobold, MD6*, Markus Chmielewski, PhD1*, Hans Christian Reinhardt, MD12, Crystal L. Mackall, MD4, Nima Abedpour, PhD2*, Peter Borchmann, MD1 and Roland T. Ullrich, MD/PhD1*

1Department 1 of Internal Medicine, University Hospital Cologne, Cologne, Germany
2Department of Translational Genomics, University of Cologne, Cologne, Germany
3Institute for Biomedical Informatics, University of Cologne, Cologne, Germany
4Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
5Institute of Pathology, University Hospital Cologne, Cologne, Germany
6Division of Clinical Pharmacology, LMU University Hospital, Munich, Germany
7Miltenyi Biotec B.V. & Co. KG, Bergisch Gladbach, Germany
8Department of Nuclear Medicine, University Hospital Cologne, Cologne, Germany
9Department of Chemistry, University of Toronto, Toronto, Canada
10Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
11Department of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
12Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

Introduction: Chimeric antigen receptor (CAR) T cell therapy has substantially improved the outcome of patients suffering from relapsed and/or refractory (r/r) aggressive B cell lymphoma. However, around 60% of patients do not show long-term remissions after CAR-T cell therapy. Recent studies have indicated a relevant role of the lymphoma microenvironment (LME) in response and resistance to CAR-T cell therapy. However, targeting the LME in aggressive B cell lymphoma to boost CAR-T cell efficacy has not yet been sufficiently explored. We therefore aimed to unravel the immunosuppressive capacity of the LME and its myelo-monocytic cell compartment with the ultimate goal to identify potential therapeutic targets and enhance CAR-T cell response.

Methods: To elucidate hallmarks associated with an immunosuppressive LME and CAR-T cell resistance in patients with r/r B cell lymphoma, we applied multi-dimensional analyses to pre- and post-CAR-T cell-treated human lymphoma specimens (n = 41), including bulk RNA sequencing, single-cell RNA sequencing of 47,078 live cells and Imaging Mass Cytometry (IMC). To validate our findings and explore the potential of new therapeutic targets, we utilized ex vivo co-culture experiments, a fully murine CD19 CAR-T cell therapy platform in an immunocompetent, autochthonous DLBCL mouse model and performed bulk RNA sequencing and IMC of diseased spleens.

Results: In our cohort of CAR-T cell treated patients (n = 104) durable response, defined as complete remission six months after CAR-T cell therapy, resulted in prolonged progression-free and overall survival. In CAR-T cell non-durable responding lymphoma patients, we identified a prognostically relevant lymphoma-associated myelo-monocytic (LAMM) signature including genes such as CD14, CD68, MARCO, ITGAM, IL1B, IL10 and S100A9. Furthermore, non-durable response was characterized by increased hypoxia and reduced (CD8+) T cell infiltration. In particular, in-depth profiling using single-cell RNA sequencing and IMC revealed a distinct CSF1R+CD14+CD68+ LAMM cell population associated with non-durable response and poor clinical outcome in CAR-T cell-treated patients with r/r B cell lymphoma. Importantly, high LAMM and low CD8+ T cell infiltration prior to CAR-T cell therapy showed a reduced progression-free survival when compared to low LAMM and high CD8+ T cell infiltration in r/r B cell lymphoma samples. Next, in ex vivo co-culture experiments we demonstrated that CSF1R+ LAMM cells strongly inhibit the proliferation and the cytotoxic capacity of CAR-T cells. To elaborate on LAMM-T cell interaction at a molecular level, we performed inference analysis of cell-cell communication in our single-cell RNA sequencing dataset using CellphoneDB which revealed that LAMM cells exert their immunosuppressive function by direct interaction with T cells via prostaglandin E2 (PGE2) and EP2/EP4 receptor signaling. Most strikingly, applying a fully autochthonous DLBCL CAR-T cell mouse model, we demonstrated that the combination of CD19 CAR-T cell therapy with CSF1R blockade switches an immunosuppressive LME into a T cell-enriched LME, which was accompanied by a follicular architecture and blood vessel normalization of diseased spleens indicated by IMC analysis. Finally, we showed that the combination of CSF1R inhibition and CD19 CAR-T cell therapy displayed synergistic treatment effects and prolonged survival with long-lasting, complete remissions.

Conclusion: Our multiomic data and preclinical models provide strong evidence that CSF1R+ LAMM cells contribute to CAR-T cell failure in r/r aggressive B cell lymphoma and that CSF1R inhibition synergistically improves CD19 CAR-T cell response, promotes an immunosupportive microenvironment and restores anti-lymphoma immunity. Given that CSF1R inhibitors have already been clinically evaluated and FDA-approved in other malignancies, this therapeutic combination has the potential for rapid clinical translation. Based on our findings, we propose to test the combination of CAR-T cell therapy and CSF1R inhibitors in patients with r/r aggressive B cell lymphoma within prospective clinical trials.

Disclosures: Good: Kite, a Gilead Company: Research Funding; 10x Genomics: Research Funding; Standard Biotools: Honoraria, Other: Travel Support; Mubadala Ventures: Consultancy; Sangamo Therapeutics: Honoraria; Boom Capital Ventures: Consultancy. Baurmann: Miltenyi Biotec B.V. & Co. KG: Current Employment. Iuga: Philips Healthcare: Speakers Bureau. Heger: Genmab: Consultancy; SERB Pharmaceuticals: Consultancy, Honoraria, Other: travel support; SOBI: Consultancy, Honoraria, Other: travel support; Novartis: Other: travel support, Research Funding; Incyte: Honoraria, Research Funding; Miltenyi Biotec: Consultancy; Roche: Honoraria. Bröckelmann: Else-Kröner Fresenius Foundation: Other: Excellence Stipend; Takeda: Consultancy, Honoraria, Research Funding; Stemline: Consultancy, Honoraria; Need Inc.: Consultancy, Current holder of stock options in a privately-held company; Merck Sharp & Dohme: Consultancy, Honoraria, Research Funding; BeiGene: Honoraria, Research Funding; BMS: Honoraria, Research Funding. Borchmann: Liqomics: Current equity holder in private company; Galapagos: Consultancy. Brägelmann: Bayer: Research Funding. Müller: Miltenyi Biotec B.V. & Co. KG: Current Employment. Kobold: CR2 Inc., Miltenyi, Galapagos, Novartis, BMS, and GS: Honoraria; CR2 Inc and Carina Biotech: Other: Licence fees; CR2 Inc., Tabby Therapeutics, Catalym GmBH, Plectonic GmBH and Arcus Bioscience: Research Funding. Reinhardt: CDL Therapeutics GmbH: Current equity holder in private company; Gilead: Research Funding; Merck: Consultancy, Honoraria; Vertex: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Janssen-Cilag: Consultancy, Honoraria; Roche: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria. Mackall: Bristol Meyers Squibb: Consultancy; Adaptimmune: Consultancy; Mammoth: Consultancy, Current equity holder in private company; Ensoma: Consultancy; Immatics: Consultancy; Lyell Immunopharma: Current equity holder in publicly-traded company, Research Funding; Link Cell Therapies: Consultancy, Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees; Cargo Therapeutics: Consultancy, Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees. Borchmann: Takeda Oncology, MSD, Incyte: Research Funding; Takeda Oncology, BMS, Roche, Amgen, Miltenyi Biotech, Gilead, MSD: Consultancy; Takeda Oncology, BMS, Roche, MSD, Celgene, Miltenyi Biotech, Gilead, Abbvie: Honoraria.

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