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1690 Asparaginase Treatment Patterns, Toxicity, and Outcomes Among Patients with Extranodal NK/T-Cell Lymphoma: A North American Multicenter Retrospective Cohort Study

Program: Oral and Poster Abstracts
Session: 625. T Cell, NK Cell, or NK/T Cell Lymphomas: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Research, Clinical Practice (Health Services and Quality), Lymphomas, Clinical Research, Health outcomes research, T Cell lymphoma, Diseases, Treatment Considerations, Lymphoid Malignancies, Adverse Events
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Pamela B. Allen, MD1, Evan Bagley, PhD2*, Kevin Graf, MD3*, Tarsheen Sethi, MD, MSc4, Francine M. Foss, MD5, Ning Dong, MD MS6, Hayder Saeed, MD7, Jie Wang, MD, MS8, Christopher Dittus, DO, MPH9, Darina Paulino, MS10*, Ryan A. Wilcox, MD, PhD11, Stefan K. Barta, MD12, Veronica Carvajal, BS13*, Neha Mehta-Shah, MD14, Eric Mou, MD15*, Aditya Ravindra, MD16*, Bradley M. Haverkos, MD, MS, MPH17, Amitkumar N. Mehta, MD18, Lauren Kelly Shea, MD, MS18, Jasmine Zain, MD19, Daniel K Reef, MD20, Ann Ayzman, MD21* and Irl Brian Greenwell, MD22

1Winship Cancer Institute at Emory University, Decatur, GA
2Medical University of South Carolina, Charleston
3Department of Hematology-Oncology, Medical University of South Carolina, Charleston, SC
4Hematology, Yale University School of Medicine, New Haven, CT
5Yale University School of Medicine, Hamden, CT
6H Lee Moffitt Cancer Center and Research Institute, Tampa
7Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
8Duke Cancer Institute, Hillsborough, NC
9Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
10Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
11Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
12Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
13University of Pennsylvania, Philidelphia
14Siteman Cancer Center, Washington University School of Medicine, Olivette, MO
15Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
16Holden Comprehensive Cancer Center, University of Iowa Healthcare, Iowa City, IA
17University of Colorado Cancer Center, Aurora, CO
18O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
19City of Hope, Duarte, CA
20Department of Medicine, Division of Oncology, University of North Carolina-Chapel Hill, Chapel Hill, NC
21Washington University in St. Louis, St. Louis, MO
22Charleston Oncology, Charleston, SC

Extranodal NK/T-cell Lymphoma (ENKTL) is a rare EBV associated lymphoma best characterized in Asian populations, with little data describing outcomes in North Americans. ENKTL has poor responses to traditional anthracycline-containing lymphoma regimens. Systemic agents such as asparaginase and gemcitabine, as well as radiation for localized disease, are considered important in improving outcomes. However, toxicity in older patients can be a limitation of therapy, especially with asparaginase based regimens. There is also no standard therapy for patients with ENKTL, especially those who may be older or have significant comorbidities. This analysis seeks to define treatment patterns and outcomes in for North American ENKTL patients with an emphasis on the impact of asparaginase use, including how asparaginase use and toxicity changes based on patient age.

A retrospective, multicenter database included patients ENKTL patients older than 18 years diagnosed between 2010 and 2022. Clinical, pathologic, treatment and survival characteristics were collected. Survival was analyzed using the Kaplan-Meier method. Cox proportional hazards regression will be used to assess the relationship of characteristics (eg asparaginase exposure) and outcome. Predictive variables with p < 0.2 from the univariable analysis will be included in a multivariable analysis. All reported p values will be 2-sided, and the significance level will be at <0.05. Analysis of outcomes with age will occur both as categorical variables (<40yo, 40-60yo, 60+), and with age as a continues variable. Due to limited expected numbers, descriptive analysis of individuals will be provided for individuals 65+ and 70+.

134 patients from 8 academic institutions were included in the analysis. 42 (31.3%) patients were younger than 40 years old, 48 patients were between the ages of 40 – 60yo (35.8%), and 44 patients (32.8%) were 61 years and older. Eighty-four patients received asparaginase (ASP) and 50 did not (non-ASP).

Grade 3+ transaminase elevations (AST or ALT >5x ULN) were common among pts receiving ASP seen in 23 of 84 patients (27%) versus those not receiving ASP (3 of 50, 6%). Lipase elevations were seen in 21 (25%) of asparaginase patients. Other notable toxicities in ASP vs non-ASP patients include hypertriglyceridemia (24% vs 0%), hypofibrinogenemia (24% vs 2%), neutropenic fever (20% vs 8%), hypersensitivity reactions (10% vs 2%), bleeding (8% vs 2%), VTE (5% vs 2%), and unplanned hospitalizations (31% vs 10%). In patients who received ASP, at least one AE was seen in 53% of patients <40yo, 68% between 40-60yo, and 66% of patients 61 years and older. Therapy related deaths were seen in 7 of the 84 patients who received ASP (8%) and in 4 of 50 patients non-ASP patients (8%). ASP was discontinued due to toxicity in 24 patients (28%).

Overall (OR) and Complete (CR) response rates were 80% (62% CR) in the ASP group and 54% (46%) in the non-ASP groups. In patients <40yo, OR (CR) rates were 82%(64%) vs 57%(42%) in ASP vs non-ASP groups. In patients aged 40-60yo, OR(CR) rates were 76%(62%) vs 52%(47%), and in patients 61+, OR(CR) rates were 81%(59%) vs 53%(47%) in ASP vs non-ASP groups. Interestingly, the higher response rates did not translate to a statistically significant advantage in overall survival (p=0.44), with difference in PFS approaching statistical significance at 0.077.

This analysis supports that ASP containing regimens have significant clinical activity in ENKTL, but are associated with significant rates of unique toxicities, resulting in discontinuation of ASP in a quarter of patients, but no increase in therapy associated death. The efficacy benefit as measured by response rates was maintained across age groups. We lacked statistical power to detect differences in survival, key subgroup analyses will be presented at the meeting in addition to other clinical, pathologic, and treatment variables. Additionally, we will discuss use of radiation, and more detailed characteristics of asparaginase dosing, and differences between chemotherapy backbones

Disclosures: Allen: Kyowa Kirin: Consultancy; ADC Therapeutics: Consultancy; Secure Bio: Consultancy. Sethi: MERCK: Research Funding. Dong: EUSA Pharma, a Recordati Group company.: Research Funding; Robert A. Winn Diversity in Clinical Trials Career Development Award, funded by Gilead Sciences: Research Funding. Saeed: Acrotech: Consultancy, Speakers Bureau; Pfizer: Speakers Bureau; Abbvie: Consultancy; ADC therapeutics: Consultancy. Wang: Regeneron: Research Funding. Barta: BMS: Consultancy; Janssen: Membership on an entity's Board of Directors or advisory committees; Acrotech: Consultancy; Kyowa Kirin: Consultancy; Daiichi Sankyo: Consultancy. Mehta-Shah: Astra Zeneca: Consultancy, Research Funding; Bristol Myers-Squibb: Research Funding; C4 Therapeutics: Consultancy, Research Funding; Celgene: Research Funding; Daiichi Sankyo: Consultancy, Research Funding; Dizal Pharmaceuticals: Research Funding; Genetech/Roche: Consultancy, Research Funding; Morphosys: Research Funding; Innate Pharmaceuticals: Research Funding; Johnson & Johnson/Janssen: Consultancy; Pfizer: Consultancy; Secura Bio: Consultancy, Research Funding; Yingli Pharmaceuticals: Research Funding; Verastem Oncology: Research Funding; Corvus Pharmaceuticals: Research Funding; Kyowa Hakko Kirin, Karyopharm Therapeutics: Consultancy. Zain: Secura Bio: Research Funding; Daichi Sankyo: Research Funding; CRISPR Therapeutic: Research Funding; Kyowa Kirin: Speakers Bureau; Astex: Research Funding; Myeloid: Research Funding; Dren-Bio: Consultancy, Research Funding; Seattle Genetics: Consultancy. Reef: Regeneron Pharmaceuticals: Current equity holder in publicly-traded company.

*signifies non-member of ASH