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382 Preliminary Safety and Efficacy of Myeloablative Orca-Q with No GvHD Prophylaxis for Treatment of Advanced Hematologic Malignancies

Program: Oral and Poster Abstracts
Type: Oral
Session: 722. Allogeneic Transplantation: Acute and Chronic GVHD and Immune Reconstitution: Monitoring, Understanding and Optimizing GVHD Interventions
Hematology Disease Topics & Pathways:
Treatment Considerations, Biological therapies, Immunotherapy, Transplantation (Allogeneic and Autologous)
Saturday, December 7, 2024: 4:45 PM

Mehrdad Abedi, MD1*, Samer A. Srour, MD2, Amandeep Salhotra, MD3, Rasmus T. Hoeg, MD1*, Edmund K. Waller, MD, PhD4, Hannah Choe, MD5, Anna Pavlova, MD, PhD6, Tamara Zharkevich, MD, PhD6*, J. Scott McClellan, MD, PhD6, Nathaniel B. Fernhoff, PhD6*, Everett H. Meyer, MD, PhD7 and Robert Lowsky, MD7*

1Comprehensive Cancer Center, University of California, Davis, Sacramento, CA
2Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
3Department of Hematology and HCT, City of Hope National Medical Center, Duarte, CA
4Emory University Winship Cancer Institute, Atlanta, GA
5Blood and Marrow Transplantation Program, James Cancer Hospital, The Ohio State University, Columbus, OH
6Orca Bio, Menlo Park, CA
7Division of Blood and Marrow Transplantation and Cellular Therapy, Stanford University School of Medicine, Stanford, CA

BACKGROUND

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potentially curative therapy for patients with advanced hematological malignancies. Conventional sources of stem cells contain T cells which promote graft versus leukemia (GvL) and graft versus infection (GvI), but also cause graft versus host disease (GvHD). Prevention of GvHD after alloHSCT routinely necessitates multi-agent immunosuppression consisting of either methotrexate or post-transplant cyclophosphamide (PTCy) combined with a calcineurin inhibitor and additional drugs. However, pharmacological immunosuppression results in poor immune reconstitution and increases the risks of organ damage, infection and disease relapse. Ex vivo pan T cell depletion (TCD) has been used to prevent GvHD without additional pharmacological control; however, the benefits are offset by increased infections and excess non-relapse mortality (NRM), as evidenced in BMT-CTN 1301. Orca-Q is a proprietary, precision engineered allogeneic T-cell immunotherapy designed to maximize GvL and GvI and to minimize GvHD. Here, we report the early clinical data using Orca-Q without any post-transplant pharmacological immunosuppression for GvHD prevention.

METHODS

Fourteen adult patients with high-risk hematologic malignancies eligible for myeloablative conditioning alloHSCT were enrolled on the HLA-identical donor dose expansion arm of a multicenter phase 1 study of Orca-Q (NCT03802695). HLA-identical donors were defined as related (n=7) or unrelated (n=7) donors with 8/8 match at HLA-A, -B, -C, and -DRB1 using high-resolution DNA typing. Orca-Q was centrally manufactured at the Orca Bio manufacturing site from G-CSF mobilized peripheral blood apheresis. Patients received no pharmacological GvHD prophylaxis. GvHD-free, relapse-free survival (GRFS) was defined as the time from transplant to the first occurrence of any of these events: grade 3-4 acute GvHD (aGvHD), moderate to severe chronic GvHD (cGvHD), disease relapse or death from any cause.

RESULTS

Orca-Q was successfully manufactured and administered to all recipients with a vein-to-vein time of less than 72 hours. As of July 11, 2024, a total of 14 patients with hematological malignancies had been treated (7 acute myeloid leukemia, 2 acute lymphocytic leukemia, 2 chronic myeloid leukemia, 3 myelofibrosis). Median age was 58.5 years (range 20-65 years), 54% of the patients were male and median follow-up was 21 months (range 1 -35 months). All patients received myeloablative conditioning, either busulfan/fludarabine/thiotepa (BFT; n=11) or total body irradiation-based (TBI; n=3).

All patients engrafted with donor cells and the median time for both neutrophil and platelet engraftment was 11 days (range 10-15 days and 10-19 days, respectively). One patient received TBI/etoposide and experienced grade 3 aGvHD that was treated to resolution. This patient subsequently developed secondary graft loss and, as of last follow-up, is still alive without disease relapse. Amongst the others, two had grade 2 aGvHD, one developed mild cGvHD, and none were reported with moderate or severe cGvHD. Two patients experienced a MOP grade 2 infection and one other experienced a MOP grade 3 infection. There were no instances of NRM among the study participants. Within the first year, 2 patients relapsed and died. At 1 year, the actuarial overall survival (OS) and RFS were both 85%, and GRFS was 77%.

BFT conditioning has shown promising disease control with Orca-T (Salhotra et al. 2023). Of the 11 Orca-Q patients who received BFT with no GvHD prophylaxis, only 2 had grade 2 aGvHD, none had grade 3 aGvHD, none had chronic GvHD (any grade), and one died from disease relapse at 1 year. The actuarial OS, RFS and GRFS were 90% at 1 year in the BFT subgroup.

CONCLUSIONS

The administration of Orca-Q without post-transplant pharmacological GvHD prophylaxis has shown promising clinical outcomes at the 1-year follow-up. Orca-Q offers similar benefits as TCD approaches, but without the compromises typically observed with TCD. Specifically, Orca-Q demonstrated low rates of GvHD and rare serious infections, and no NRM was reported. Orca-Q may provide a bridge to immunocompetency and also separate harmful GvHD alloreactivity from beneficial GvT alloreactivity. Disease control may be further augmented by BFT conditioning. The Orca-Q Phase 1 study continues to enroll patients across the US.

Disclosures: Abedi: BMS, Autolus: Consultancy; CytoDyn: Current holder of stock options in a privately-held company; AbbVie, BMS and Gilead Sciences: Speakers Bureau; Autolus, BMS and Gilead Sciences: Research Funding; Orca Bio: Research Funding. Srour: Hansa Biopharma: Consultancy; Orca Bio: Research Funding. Hoeg: Orca Bio: Research Funding. Waller: Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Biolinerx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Allogene: Consultancy, Membership on an entity's Board of Directors or advisory committees; CSL: Consultancy, Membership on an entity's Board of Directors or advisory committees; Forte Bioscience: Consultancy, Membership on an entity's Board of Directors or advisory committees; Cambium Medical Technologies: Current equity holder in private company; Cambium Oncology: Current equity holder in private company; Doximity: Current equity holder in private company. Choe: REGiMMUNE: Consultancy; Orca Bio: Consultancy; AbbVie: Consultancy; Incyte: Consultancy; Ironwood Pharmaceuticals, Inc.: Consultancy; Sanofi: Consultancy; Actinium: Consultancy. Pavlova: Orca Bio: Current Employment, Current holder of stock options in a privately-held company. Zharkevich: Orca Bio: Current Employment, Current holder of stock options in a privately-held company. McClellan: Orca Bio: Current Employment, Current holder of stock options in a privately-held company. Fernhoff: Orca Bio: Current Employment, Current holder of stock options in a privately-held company. Meyer: Orca Bio: Research Funding. Lowsky: Orca Bio: Research Funding.

*signifies non-member of ASH