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4840 Safety and Efficacy of CD22/ CD19 CAR-T and Auto-HSCT “Sandwich”Strategy As Consolidation Therapy for Ph Negative B Cell Acute Lymphoblastic Leukemia

Program: Oral and Poster Abstracts
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: Poster III
Hematology Disease Topics & Pathways:
Clinical trials, Research, Lymphoid Leukemias, ALL, Combination therapy, Adult, Clinical Research, Diseases, Treatment Considerations, Lymphoid Malignancies, Young adult , Study Population, Human
Monday, December 9, 2024, 6:00 PM-8:00 PM

Zihao Wang1,2*, Chong-Sheng Qian2,3*, Yan Qiu4*, Hai-xia Zhou2,3*, Mingzhu Xu2,5*, Li-Qing Kang6*, Ai-Ning Sun2,3*, Depei Wu, MD, PhD2,7, Lei Yu6* and Sheng-Li Xue2,8*

1National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, CA, China
2Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
3National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
4The First People’s Hospital of Changzhou, Changzhou, China
5The first Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center of Hematologic Diseases, Suzhou, China
6Shanghai Unicar-Therapy Bio-Medicine Technology Co.,Ltd, Shanghai, China
7Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
8Department of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou, China

Introduction: Chimeric antigen receptor T-cell (CAR-T) therapy has shown an impressive remission rate in relapsed and refractory B-ALL, however relapse after CAR-T cell therapy is currently the challenging issue. Multiantigen CAR-T cells and the combination of CAR-T cells with other regimens may reduce the relapse rate and prolong leukemia-free survival (LFS) and overall survival (OS). The main purpose of this study is to observe the safety and efficacy of CD22/CD19 CAR-T and Auto-HSCT “Sandwich” strategy in Ph negative (Ph-) B-ALL patients.

Methods: A total of 33 newly diagnosed Ph- B-ALL patients were enrolled in this study (NCT05470777). These patients received induction and consolidation chemotherapy according to standard protocols. Autologous lymphocytes were collected at week 4 after induction chemotherapy. Afterwards, autologous CAR T-cells targeting CD22 and CD19 (CAR-T 1, co-stimulatory molecule was 4-1BB and infusion dose was 5×106/kg, respectively) were sequential infused after lymphodepletion chemotherapy with fludarabine and cytophosphamide. Autologous stem cells mobilization and collection were performed at 6-8 weeks after CAR T-cells infusion. After conditioned with modified BuCy regimen, autologous stem cells transplantation (auto-HSCT) was conducted. Sequential infusion of CD22 and CD19 CAR-T cells was performed on the second day after transplantation (CAR-T 2, co-stimulatory molecules and dose as CAR-T 1). No maintenance therapy was performed after auto-HSCT. Measurable detectable disease (MRD) was monitored by flow cytometry and IGHV leader-based next generation sequencing. Persistence of CAR T-cells were detected using real time quantitative RT-PCR (qPCR).

Results: Three of the enrolled patients were Ph-like B-ALL. Twenty (60.6%) patients had poor-risk factors according to NCCN guidelines. Grade 1-2 cytokine release syndrome (CRS) occurred in 7(22.6%) and 8(25.8%) patients after CAR-T 1 and CAR-T 2, respectively. No severe CRS (Grade 3-4) or immune effector cell associated neurotoxicity syndrome (ICANS) occurred. After CAR-T 1 therapy, all patients achieved MRD negative complete remission (MRD-CR). Until the last follow-up on July 1st, 2024, the median follow-up was 21 months (range, 6-44 months). Thirty two (96.7%) patients are alive and 26 (78.8%) patients remain MRD-CR. Duration of continuous MRD-CR was observed in 9 patients for more than 2 years and in 19 patients for more than 1 year. The median OS and leukemia-free survival LFS are not reached. Two (5.4%) patients experienced relapse after CAR-T 1 and 5 (13.5%) patients after CAR-T 2, all of them experienced CD19 positive relapse. The median recurrence time of patients who completed “Sandwich” strategy was 5 months (range, 3-10 months). Four of 7 relapsed patients received allo-HSCT, 2 relapsed patients who declined allo-HSCT received Blinatumomab, and 1 patient was undergoing the chemotherapy as re-induction treatment. Five of them were still in MRD-CR with a median remission duration of 11 months (range, 3-15 months). One patient who relapsed after CAR-T 1 died of disease progression at 3 months after allo-HSCT,

Conclusions: Our preliminary study demonstrated that CD22/CD19 CAR-T and Auto-HSCT “Sandwich” strategy as a consolidation strategy showed favorable safety and efficacy in Ph- B-ALL. CD22/CD19 CAR-T resulted in deeper remission before transplantation. The new strategy may benefit patients from LFS and OS.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH