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3373 Belantamab Mafodotin As Pre- and Post-Autologous Stem Cell Transplant (ASCT) Consolidation and Maintenance for Multiple Myeloma (MM) with < Complete Response after Induction: Interim Results of the Ongoing Phase 2 BLAST Study

Program: Oral and Poster Abstracts
Session: 654. Multiple Myeloma: Pharmacologic Therapies: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical trials, Adult, Clinical Research, Plasma Cell Disorders, Diseases, Lymphoid Malignancies, Study Population, Human
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Adam D. Cohen, MD1, Sandra Susanibar-Adaniya, MD2, Oksana De Mesa, BSN, RN2*, Alfred L. Garfall, MD2, Dan T. Vogl, MD, MS2, Adam Waxman, MD2*, Shivani Kapur, MD2, E Paul Wileyto3*, Anjana Nair2*, Zainul S. Hasanali, MD, PhD4, Lauren Karpf5* and Edward A. Stadtmauer, MD2

1Abramson Cancer Center, Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA
2Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
3Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadephia, PA
4Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
5Office of Clinical Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Background: High dose melphalan and ASCT, followed by lenalidomide (len) maintenance, improves progression-free survival (PFS) in MM but is generally not curative. Achieving a minimal residual disease (MRD)-negative state 12 months post-ASCT predicts for prolonged PFS and overall survival (OS). Belantamab mafodotin (belamaf) is a BCMA-targeted antibody-drug conjugate with activity in relapsed/refractory MM. We hypothesized that reduced-frequency belamaf with ASCT and len maintenance would be feasible and improve MRD-negative rates and clinical outcomes.

Study Design and Methods: This is an ongoing investigator-initiated, single institution, phase 2 study (NCT04680468). Subjects have newly-diagnosed MM with at least partial response (PR), but not complete response (CR), after ≥4 cycles of induction therapy, and meet institutional criteria for ASCT. They receive 1 dose of belamaf on day (D) -42 (relative to ASCT), followed by stem cell collection starting D -14, and ASCT on D0. They restart belamaf on D+60, continuing every 3 months until 2 years post-ASCT, in conjunction with standard len maintenance starting D+100, given until progression. Subjects undergo serial ophthalmologic exams, with belamaf dose reductions and/or holds for corneal toxicity. Bone marrow MRD is assessed at 3, 12 and 24 months post-ASCT by next generation sequencing (NGS, Adaptive Clonoseq). The primary endpoint is the rate of MRD-negativity (at 10-6 sensitivity) 12 months post-ASCT.

Results: As of 7/1/24, 24 subjects (15 M and 9 F; median age 61 (range 37-72); 20 White, 4 Black) had received ≥1 dose of belamaf. R-ISS at diagnosis was stage 1 in 29%, 2 in 38%, 3 in 13%, and unknown in 21%. Fifteen (63%) had high risk cytogenetics, with 7 (29%) having ≥2 high risk features. One (4%) and 8 (33%) had extramedullary and paramedullary disease, respectively. Induction regimens were VRd in 29%, DaraVRd in 58% and other in 13%, with 67% receiving an anti-CD38 antibody. Responses at enrollment: 9 (38%) in PR and 15 (63%) in VGPR. The 1st 13 subjects started belamaf at 2.5 mg/kg; 8 had either their 2nd (D+60) or 3rd (D+150) dose skipped due to corneal toxicity, with 3 choosing to discontinue belamaf after 1 dose. After an amendment, subsequent subjects started at 1.9 mg/kg, with only 1 missed dose so far, and no discontinuations.

Of 17 subjects who have received at least 2 belamaf doses, 13 have required ≥1 dose reduction, with 7 having 2 dose reductions. Ocular toxicities were the most common treatment-emergent adverse events (TEAEs, n=22 with at least 1 follow-up visit post-belamaf), including keratopathy (100%, Gr 3 9%), blurred vision (91%, Gr 3 0%), decreased visual acuity (91%, Gr 3 41%), dry eye (68%, Gr 3 0%), photophobia and eye pain (32% each, Gr 3 0%). No grade 4 ocular toxicities were noted. Other common TEAEs included thrombocytopenia (45%, Gr 3/4 9%), upper respiratory infection (45%, Gr 3/4 0%), fatigue and leukopenia (36% each, Gr 3/4 0%), neutropenia, flu-like symptoms, and diarrhea (27% each, Gr 3/4 0%), myalgias (23%, Gr 3/4 0%), and increased ALT (23%, Gr 3/4 5%). Ten serious AE’s were seen in 7 subjects, including 1 grade 5 cardiac arrest D+132 post-ASCT in a patient with multiple cardiovascular co-morbidities, unrelated to study treatment. Belamaf had no apparent impact on stem cell collection (median 9.3x106 CD34+/kg in median 2 days) or post-ASCT engraftment (median time to ANC>1000 and platelets>50 of 11 and 15 days, respectively).

Seventeen subjects have reached the D+90 response assessment; all were able to start len maintenance, with 3 requiring dose reductions and none requiring len discontinuation. Best responses to date in these subjects are VGPR in 24% and sCR in 76%. At D+90, 14 were MRD-evaluable (2 had no baseline clone identified, 1 refused BM biopsy), with 9 (64%) MRD-neg at 10-5 and 8 (57%) at 10-6. At 12 months post-ASCT, 12 are MRD-evaluable (2 not yet at M12, 1 no baseline clone, 1 expired, 1 progressed), with 10 (83%) MRD-neg at 10-5 and 8 (67%) at 10-6. With median follow-up of 15.5 months (range 0.5 – 36), 1 patient has progressed at D+187, with 1-year PFS and OS estimates of 87% and 93%, respectively.

Conclusions: In newly-diagnosed MM patients with <CR after induction, belamaf every 3 months in conjunction with ASCT and len maintenance appears feasible (at 1.9 mg/kg starting dose), with expected reversible ocular toxicities, and so far has promising rates of sCR, MRD-negativity, and PFS. Accrual and follow-up are ongoing.

Disclosures: Cohen: Novartis: Patents & Royalties; Ichnos: Membership on an entity's Board of Directors or advisory committees; University of Pennsylvania: Current Employment; Roche/Genentech, Janssen, GSK, AstraZeneca, BMS, Pfizer, AbbVie, iTeos, Arcellx, Legend, Sanofi: Consultancy; GSK, Novartis, Roche/Genentech, Janssen: Research Funding. Garfall: Tmunity Therapeutics: Research Funding; Crispr: Research Funding; GSK: Consultancy; Amgen: Consultancy; Novartis: Research Funding; Janssen: Consultancy, Research Funding. Vogl: Abbvie: Consultancy; GlaxoSmithKline: Consultancy; BMS: Consultancy; Active Biotech: Research Funding; Takeda: Consultancy, Research Funding; Genentech: Consultancy. Stadtmauer: Celgene, Takeda, Novartis, Teva, Janssen, Amgen, Sanofi: Consultancy; Astra zeneca: Research Funding.

OffLabel Disclosure: This abstract describes the use of belantamab mafodotin, an anti-BCMA antibody-drug conjugate, for multiple myeloma patients with less than a complete response after induction therapy.

*signifies non-member of ASH