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4837 Healthcare Resource Utilization and Costs Associated with Managing CRS and ICANS in Patients with Relapsed/Refractory Adult B-Cell Acute Lymphoblastic Leukemia Receiving Obecabtagene autoleucel (obe-cel)

Program: Oral and Poster Abstracts
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: Poster III
Hematology Disease Topics & Pathways:
Clinical trials, ALL, Adult, Chimeric Antigen Receptor (CAR)-T Cell Therapies, Adverse Events
Monday, December 9, 2024, 6:00 PM-8:00 PM

Bijal D Shah, MD1, Jeremy Pantin, MD2*, Karamjeet S Sandhu, MD3, Elias Jabbour, MD4, Jae H. Park, MD5, Paul Shaughnessy, MD6, Mehrdad Abedi, MD7*, Michael R Bishop, MD8, Daniel J. DeAngelo, MD, PhD9, Wolfram Brugger, MD10*, Martin Brown, MSc11*, Dilip Patel, BSc11*, Claire Roddie, MD12* and Aaron C. Logan, MD, PhD13

1Moffitt Cancer Center, Tampa, FL
2Sarah Cannon Transplant and Cellular Therapy Program, Nashville, TN
3City of Hope National Medical Center, Duarte, CA
4University of Texas MD Anderson Cancer Center, Houston, TX
5Memorial Sloan Kettering Cancer Center, New York, NY
6Sarah Cannon Transplant and Cellular Therapy Program, Methodist Hospital, San Antonio, TX
7University of California Davis, Davis, CA
8The David and Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL
9Dana-Farber Cancer Institute, Boston, MA
10Autolus Therapeutics, Munich, Germany
11Autolus Therapeutics, London, United Kingdom
12University College London Cancer Institute, London, United Kingdom
13Hematology, Blood and Marrow Transplantation, and Cellular Therapy Program, University of California at San Francisco, San Francisco, CA

Background: Chimeric antigen receptor (CAR) T-cell therapies for relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) have dramatically improved survival outcomes but are associated with high rates of adverse events (AEs) such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), contributing to increased healthcare costs associated with this treatment modality. Obe-cel is an autologous CD19-directed CAR T-cell therapy with a differentiated fast off-rate CD19 binding domain, a 4-1BB co-stimulatory domain and tumor burden-guided dosing, designed with the potential to improve persistence and reduce toxicity. Currently, there is a paucity of research documenting the costs related to managing CRS/ICANS among patients with R/R B-ALL treated with CAR T-cell therapy. This analysis evaluated healthcare resource utilization (HCRU) and estimated costs of managing CRS and/or ICANS events by grade in patients with R/R B-ALL who received obe-cel treatment in the FELIX study.

Methods: FELIX (NCT04404660) is an open-label, multi-center, global, single-arm Phase Ib/II study evaluating the safety and efficacy of obe-cel in adult patients with R/R B-ALL. A secondary analysis was conducted to evaluate HCRU as a result of CRS and ICANS, and estimate the overall costs for managing these AEs among patients with R/R B-ALL. HCRU for patients with treatment-emergent CRS and/or ICANS was monitored for 6 months post obe-cel administration. Results were stratified by, and specific to, AE type (non-overlapping CRS or ICANS, and overlapping CRS and ICANS) and grade. CRS AEs were graded per ASTCT/ASBMT 2019 CRS consensus grading and NCI-CTCAE v5.0; ICANS AEs were graded per ASTCT/ASBMT 2019 consensus criteria. Costs associated with managing CRS and/or ICANS were estimated using a micro-costing methodology: 1) AE-specific HCRU from the time of AE onset through resolution was identified for patients in the FELIX study; 2) the most recently available unit costs sourced from public databases or literature (US Centers for Medicare and Medicaid Services, Healthcare Cost and Utilization Project, and Merative™ Micromedex® RED BOOK®) were applied to each HCRU and adjusted to 2023 US dollars using the consumer price index. Key HCRU captured for each AE included hospitalizations (standard inpatient and intensive care unit [ICU]), length of stay, office visits, laboratory and imaging, procedures (e.g. dialysis, mechanical ventilation), and pharmacy (e.g. oncology supportive care, prophylactics). HCRU was reported as event-level utilizations unless otherwise stated. Data cut-off for this analysis was 13 September 2023.

Results: In FELIX, 127 patients received obe-cel, of whom 88 (69.3%) experienced a CRS and/or ICANS AE. Of these 88 patients, 47.7% were male, 70.5% were white, 59.1% were not Hispanic or Latino, and mean (standard deviation) age was 48.6 (16.7) years. Overall, a total of 102 CRS and/or ICANS AEs were reported: 72 (70.6%) were CRS only, 13 (12.7%) ICANS only, and 17 (16.7%) overlapping CRS and ICANS. Few patients (n=11) experienced Grade ≥3 CRS and/or ICANS AEs. There were three non-overlapping CRS AEs, three non-overlapping ICANS AEs, and six overlapping CRS and ICANS AEs with at least one AE (CRS or ICANS) of Grade ≥3. Mean AE duration was shorter for Grade <3 vs Grade ≥3 AEs (7.5 vs 19.8 days, respectively). Overlapping CRS and ICANS AEs had the highest mean total costs followed by ICANS only and CRS only events. The mean cost for treating a patient with Grade ≥3 vs Grade <3 CRS and/or ICANS was $44,298 vs $7,464 (~6-fold increase in cost for Grade ≥3 events). Medication usage (in particular tocilizumab) and hospitalization/ICU costs were key drivers of overall CRS and/or ICANS management costs (64.2% and 27.1%, respectively). Most events did not include an inpatient or ICU hospitalization.

Conclusions: Grade ≥3 CRS and/or ICANS AEs are associated with increased HCRU, but these events were rare in the FELIX study. Obe-cel is designed to improve efficacy and decrease toxicity through use of a novel targeting construct and tumor burden-guided split dosing, offering a potential solution to optimize utilization of resources and reduce costs associated with CAR T-cell therapy for patients with B-ALL.

Disclosures: Shah: Bristol Myers Squibb: Consultancy; Jazz Pharmaceuticals: Consultancy; Eli Lilly: Consultancy; Kite Pharma: Consultancy; AstraZeneca: Consultancy; Amgen: Consultancy; Adaptive Biotechnologies: Consultancy; Autolus, Beigene, Century Therapeutics, Deciphera, Jazz, Kite/Gilead, Pfizer, Precision Biosciences, Novartis, Takeda: Consultancy; Jazz Pharmaceuticals, Kite-Gilead, Servier: Research Funding; Pepromene Bio: Other: DSMB. Pantin: Omeros, Sanofi, BMS: Speakers Bureau; HCA Healthcare, Inc.: Current Employment; BMS, Omeros, Sanofi, Autolus, MaaT Pharma: Honoraria. Sandhu: Autolus: Consultancy. Jabbour: AbbVie, Adaptive Biotechnologies, Amgen, Astellas Pharma, BMS, Genentech, Incyte, Pfizer, Takeda: Consultancy; AbbVie, Adaptive Biotechnologies, Amgen, Ascentage Pharma Group, Pfizer, Takeda: Research Funding. Park: Adaptive Biotechnologies, Affyimmune, Allogene, Amgen, Artiva Biotherapeutics, Autolus, Bright Pharmaceutical Services, BMS, Caribou Biosciences, Curocell, Galapagos, Gilead Sciences, Intellia, In8Bio, Kite, Novartis, Pfizer, Servier, Sobi, Synthekine: Consultancy; Curocell: Current equity holder in publicly-traded company; Autolus, Fate Therapeutics, Genentech, InCyte, Servier, Sobi, Takeda (Institution): Research Funding; Takeda: Consultancy. Shaughnessy: BMS: Speakers Bureau; Sanofi: Speakers Bureau; Autolus, Sanofi: Consultancy. 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. Bishop: Incyte: Honoraria; Achieve Clinics, Arcellx, Autolus, BMS, Chimeric Therapeutics, CRISPR Therapeutics, In8Bio, Iovance Biotherapeutics, Kite-Gilead, Optum Health, Novartis, Sana Biotechnology: Consultancy; Servier: Consultancy, Honoraria, Speakers Bureau; Sana Biotechnology: Consultancy, Honoraria; Kite/Gilead: Consultancy, Honoraria, Research Funding, Speakers Bureau; AstraZeneca: Honoraria, Speakers Bureau; Iovance Biotherapeutics: Consultancy; ADC Therapeutics: Honoraria, Speakers Bureau; GenMab: Honoraria, Speakers Bureau; Galapagos: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; In8bio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Chimeric Therapeutics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; CRISPR Therapeutics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Meyer-Squibb: Consultancy, Honoraria, Speakers Bureau; Achieve Clinics, In8Bio: Current holder of stock options in a privately-held company; Arcellx, Autolus, Bristol-Myers Squibb, CRISPR Therapeutics, Lyell, Gilead Sciences and Novartis: Research Funding; AbbVie, ADC Therapeutics, Bristol-Myers Squibb, Gilead Sciences, Incyte, Novartis, Sanofi and Servier: Honoraria, Speakers Bureau. DeAngelo: Daiichi-Sankyo, Fibrogen: Other: DSMB; Mt Sinai MPN Consortium: Other: Mt Sinai MPN Consortium; AbbVie, Blueprint, GlycoMimetics, Novartis: Research Funding; Amgen, Autolus, Blueprint, Gilead, Incyte, Jazz, Novartis, Pfizer, Servier, Takeda: Consultancy; Dana-Farber Cancer Institute: Current Employment. Brugger: Autolus: Current Employment, Current equity holder in publicly-traded company. Brown: Autolus: Current Employment, Current equity holder in publicly-traded company. Patel: Autolus: Current Employment, Current equity holder in publicly-traded company. Roddie: Autolus, BMS, Gilead, Janssen: Consultancy; Autolus, BMS, Gilead: Honoraria, Speakers Bureau. Logan: Kite/Gilead: Research Funding; Bristol Myers Squibb: Consultancy; AbbVie: Consultancy; Kadmon/Sanofi: Research Funding; Pharmacyclics: Research Funding; Kite: Consultancy; Pfizer: Consultancy; Talaris: Research Funding; Autolus: Research Funding; Sanofi: Consultancy; Amgen: Consultancy, Research Funding; Actinium: Consultancy; Astellas Pharma: Research Funding; Takeda: Consultancy.

*signifies non-member of ASH