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4332 Prospective Evaluation of the Impact of Measurable Residual Disease (MRD) By Error Corrected Next-Generation Sequencing (NGS) with CPX-351 in Acute Myeloid Leukemia (AML)

Program: Oral and Poster Abstracts
Session: 619. Acute Myeloid Leukemias: Disease Burden and Minimal Residual Disease in Prognosis and Treatment: Poster III
Hematology Disease Topics & Pathways:
Clinical trials, Research, Clinical Research, Measurable Residual Disease
Monday, December 9, 2024, 6:00 PM-8:00 PM

David Sallman, MD1, Amy F McLemore, MS2*, Onyee Chan, MD3, Andrew T. Kuykendall, MD1, Eric Padron, MD1, Zhuoer Xie, MD, MS3, Alison R. Walker, MD, MBA, MPH4, David H Spencer, MD, PhD5, Rami S. Komrokji, MD3, Jeffrey E Lancet, MD1 and Meagan Jacoby, MD6

1Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
2Malignant Hematology Department, Moffitt Cancer Center, Tampa, FL
3Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
4Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Wesley Chapel, FL
5Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St Louis, MO
6Washington University-School of Medicine, Richmond Heights, MO

Introduction

CPX-351 treatment significantly improved overall survival (OS) versus 7+3 in secondary AML patients in a Phase 3 study, particularly in patients bridged to allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a median OS that was not reached (Lancet et al., JCO 2018, Uy G et al., Blood Advances 2022). However, there have been minimal data on the impact of molecular MRD and outcomes with CPX-351.

Methods

We prospectively collected bone marrow aspirates from AML patients treated with CPX-351 at Moffitt Cancer Center and Washington University. At each time point (pre-treatment/post-induction/post-consolidation/day+30 post-HSCT/relapse (as applicable)), we utilized a novel, ultra-deep, error-corrected gene panel (Myeloseq-HDTM Capture Assay) that targets 49 genes that are mutated in myeloid malignancies for the purposes of mutation identification at diagnosis and disease monitoring after therapy (raw sequencing depth >50,000x and consensus read depth >4000x, which allows for detection of previously known variants at variant allele fractions (VAFs) greater than or equal to 0.1%.) Patients with variants detected only in DNMT3A, TET2, and/or ASXL1 (DTA) were considered MRD negative (occurred in 1 pre-HSCT and 2 post-HSCT samples). GraphPad Prism was used for survival analyses and relapse free survival (RFS), event free survival (EFS), and OS were calculated from date of CPX-351 initiation. EFS was defined as either relapse or death. For all endpoint analyses, an MRD cutoff of 0.1% VAF was used.

Results

A total of 48 patients were consented on study and treated with CPX-351 per standard of care/FDA indication with 33 patients having sequential NGS analysis. CR/CRi was achieved in 58% of patients (28/48). With a median follow up of 22.5 months, the median OS of the entire cohort was 15.8 months. Of the cohort, 56% of patients (n=27) were bridged to allo-HSCT with improved OS in transplanted patients compared to non-transplanted patients (22.5 vs 8 months, P=.007). Similarly, 37% of patients were alive at 2 years post-HSCT (n=10) vs 14% without HSCT (n=3). Patients with IDH1/2 and/or NPM1 mutation had improved CR/CRi rates (92% (12/13) vs 55% (11/20), P=.04). No other individual mutation or class of mutations predicted for response. Patients with secondary type mutations as defined by WHO achieved CR/CRi in 62% of cases. Only 3 TP53 mutant patients were treated and 1 achieved CR. Of the 33 patients with serial NGS, 13% of patients with CR/CRi (3/23) achieved MRD negativity at the 0.1% threshold post induction and/or consolidation. Of these, 2 patients did not proceed to allo-HSCT with one patient that is alive and disease free at 47 months (NPM1 mutant). We additionally analyzed NGS cutoffs of 1% and 5% for the entire cohort, but this was not predictive of OS, EFS, or RFS. For patients not proceeding to allo-HSCT, we additionally analyzed 1% and 5% NGS cutoffs, which were not predictive of OS, EFS or RFS. Among mutation-defined subsets, only patients with IDH1/2mutations with clearance of mutation to < 1% had an improved RFS (P=.04) although there was no improvement in OS. The one patient who achieved MRD negativity prior to allo-HSCT was alive and disease free at 38.6 months (ASXL1, IDH2, STAG2, and ZRSR2). NGS clearance cutoffs of 1% and 5% pre-allo-HSCT were not predictive of outcomes. 8 patients had post allo-HSCT MRD measured (Day +30) and 88% (n=7) were MRD negative. The median OS, EFS and RFS were not reached in these patients with improved EFS/RFS versus the entire cohort (P<.05).

Conclusions

In this prospective real-world cohort of CPX-351 treated AML patients, outcomes were similar to the Phase 3 trial with > 50% of patients proceeding to allo-HSCT and with encouraging rates of prolonged survival. Patients with NPM1/IDH1/IDH2 had distinctly favorable outcomes. Molecular MRD clearance to < 0.1% was rare with CPX-351 treatment, suggesting the need for novel frontline combinations to increase molecular MRD negativity. However, patients treated with CPX-351 and bridged to allo-HSCT had very high day +30 MRD negative rates and excellent outcomes (85% without relapse).

Disclosures: Sallman: Abbvie: Consultancy; Agios: Consultancy; Axiom: Consultancy; Gilead: Consultancy; Celyad: Consultancy; Froghorn: Consultancy; Incyte: Consultancy; Intellisphere, LLC: Consultancy; Johnson & Johnson: Consultancy; Kite: Consultancy, Membership on an entity's Board of Directors or advisory committees; Magenta Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; NextTech: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; AvenCell: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; BlueBird Bio: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Dark Blue Therapeutics: Membership on an entity's Board of Directors or advisory committees; Intellia: Membership on an entity's Board of Directors or advisory committees; Jasper Therapeutics: Membership on an entity's Board of Directors or advisory committees; NKARTA: Membership on an entity's Board of Directors or advisory committees; Orbital Therapeutics: Membership on an entity's Board of Directors or advisory committees; Rigel Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Shattuck Labs: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Syndax: Membership on an entity's Board of Directors or advisory committees; Syros: Membership on an entity's Board of Directors or advisory committees; Apera: Research Funding; Jazz: Research Funding. Chan: AbbVie: Honoraria, Research Funding; Aptitude Health: Honoraria; Syndax: Membership on an entity's Board of Directors or advisory committees; Jazz: Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Kuykendall: PharmaEssentia: Honoraria; Novartis: Research Funding; Protagonist Therapeutics: Honoraria, Research Funding; Incyte: Honoraria. Komrokji: AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; CTI biopharma: Membership on an entity's Board of Directors or advisory committees; Celgene/BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Servier: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Genentech: Consultancy; PharmaEssentia: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Geron: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sumitomo Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Rigel: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS: Research Funding; Servio: Membership on an entity's Board of Directors or advisory committees; Keros: Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees; DSI: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy; DSI: Honoraria, Membership on an entity's Board of Directors or advisory committees; Servio: Honoraria; Taiho: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Lancet: Bristol Myers Squibb: Consultancy, Other: Consultant/Advisory Board; Prelude Therapeutics: Consultancy, Other: Bristol Myers Squibb; Tradewell Therapeutics: Consultancy, Other: Consultant/Advisory Board. Jacoby: Jazz Pharmaceuticals: Research Funding; Taiho Pharmaceuticals: Research Funding; AstraZeneca: Research Funding; Agios: Research Funding.

*signifies non-member of ASH