Expansion, Persistence and Pharmacodynamic Profile of ADI-001, a First-in-Class Allogeneic CD20-Targeted CAR Gamma Delta T Cell Therapy, in Patients with Relapsed/Refractory Aggressive B-Cell Non-Hodgkin's Lymphoma

Abstract

Introduction ADI-001 is a first-in-class allogeneic gamma delta (γδ) CAR T cell therapy targeting the B-cell antigen, CD20. Expansion and persistence of cell therapy products and release of functional cytokines have historically correlated with patient outcomes. Here we report cellular kinetics and pharmacodynamic correlates from a phase 1, multicenter, open-label, dose escalation study to evaluate ADI-001 in R/R B cell NHL. Methods Cellular kinetics of ADI-001 were measured using three orthogonal methods, including quantitative SNP profiling of cell product (AlloCell), flow-cytometry for CAR+ Vδ1 γδ T cells, and droplet digital PCR (ddPCR) quantification of CAR transgene copies. Using these methods, expansion of ADI-001 was assessed in the peripheral blood for 24 evaluable patients across four dose levels in association with a phase 1 dose-escalation trial (NCT04735471). Relationships between ADI-001 cellular kinetics and radiographic clinical responses were also examined. Serum biomarkers related to host immune cell recovery during lymphodepletion and cytokine release were monitored for pharmacodynamic purposes. Humoral immunogenicity was assessed by Luminex™-based anti-HLA antibody screening. Other correlative characteristics were also evaluated, including degree of HLA mismatching between patient and ADI-001 product in relation to response and/or ADI-001 expansion and persistence. Results As of the May 2023 cutoff for reporting, ADI-001 was detected at all dose levels using ddPCR and flow cytometry to quantify CAR transgene copies and CAR+ Vδ1 γδ T cells, respectively. Treatment at the highest dose level, achieved a notable mean C max of 201,666 copies/µg or 483 CAR+ cells/µl, and mean day 28 persistent exposure of 16,553 copies/µg or 21 CAR+ cells/µL. Additional measures of ADI-001 exposure (AlloCell) further demonstrated a robust dose-dependent expansion profile of ADI-001 in the peripheral blood. Subjects with a BOR of CR or PR were observed to have a mean peak of 180,107 CAR copies/µg versus a mean peak of 20,950 CAR copies/µg in subjects with a BOR of SD or PD. Additionally, as expected following lymphodepletion, a transient increase in the homeostatic cytokine IL-15, coinciding with ADI-001 expansion and host-mediated immune cell recovery, was observed. Using high-resolution HLA typing, the degree of HLA mismatch between allogeneic ADI-001 product and patients did not associate with degree of cellular expansion, day 28 persistence, or response. Finally, emergence of donor-specific anti-drug antibodies following treatment was not observed. Conclusions Using three orthogonal measures of exposure, we show for the first time robust dose-dependent expansion and persistence of an allogeneic CAR γδ T cell therapy, ADI-001, irrespective of extensive degree of HLA mismatch. ADI-001 C max and D28 persistent exposure were comparable to, or exceeded, those demonstrated by alternative allogeneic CAR T therapies and approved autologous CD19 CAR T therapies. Favorable clinical responses were also associated with higher mean and median peak of ADI-001 cells.