T-cell Receptor Alpha Constant Research Articles

Metabolic priming of GD2 TRAC-CAR T cells during manufacturing promotes memory phenotypes while enhancing persistence

Manufacturing chimeric antigen receptor (CAR) Tcell therapies is complex, with limited understanding of how medium composition impacts Tcell phenotypes. CRISPR-Cas9 ribonucleoproteins can precisely insert a CAR sequence while disrupting the endogenous Tcell receptor alpha constant (TRAC) gene resulting in TRAC-CAR Tcells with an enriched stem cell memory Tcell population, a process that could be further optimized through modifications to the medium composition. In this study we generated anti-GD2 TRAC-CAR Tcells using "metabolic priming" (MP), where the cells were activated in glucose/glutamine-low medium and then expanded in glucose/glutamine-high medium. Tcell products were evaluated using spectral flow cytometry, metabolic assays, cytokine production, cytotoxicity assays invitro, and potency against human GD2+ xenograft neuroblastoma models invivo. Compared with standard TRAC-CAR Tcells, MP TRAC-CAR Tcells showed less glycolysis, higher CCR7/CD62L expression, more bound NAD(P)H activity, and reduced IFN-γ, IL-2, IP-10, IL-1β, IL-17, and TGF-β production at the end of manufacturing exvivo, with increased central memory CAR Tcells and better persistence observed invivo. MP with medium during CAR Tcell biomanufacturing can minimize glycolysis and enrich memory phenotypes exvivo, which could lead to better responses against solid tumors invivo.

Updated Results of the Phase I BALLI-01 Trial of UCART22 Process 2 (P2), an Anti-CD22 Allogeneic CAR-T Cell Product Manufactured By Cellectis Biologics, in Patients with Relapsed or Refractory (R/R) CD22+ B-Cell Acute Lymphoblastic Leukemia (B-ALL)

Introduction: UCART22 is a genetically modified allogeneic T-cell product manufactured from healthy donor cells. Donor-derived T-cells are transduced using a lentiviral vector to express the anti-CD22 chimeric antigen receptor (CAR) and are further modified using Cellectis' TALEN ® technology to disrupt the T-cell receptor alpha constant ( TRAC) and CD52 genes to minimize risk of graft-vs-host disease (GvHD) and allow use of an anti-CD52 antibody for lymphodepletion (LD). Preliminary results from patients treated with UCART22 manufactured by a CMO (Process 1 (P1)) showed that UCART22 was well-tolerated and meaningful responses were achieved at the highest dose level (DL 3; 5 x 10 6 cells/kg). The fludarabine, cyclophosphamide, and alemtuzumab (FCA) LD regimen was also shown to extend host lymphocyte suppression and improve UCART22 expansion versus fludarabine and cyclophosphamide (FC) alone (Boissel N, et al. EHA 2023). We now report updated results from the BALLI-01 study that includes the first patients treated with UCART22 Process 2 (P2) manufactured by Cellectis Biologics. Methods: The primary endpoints are safety, tolerability, and determining the MTD/RP2D of UCART22. Additional endpoints are anti-leukemic activity and expansion of UCART22. Eligibility criteria include age 15‒70y, B-ALL blast CD22 expression ≥ 70%, and ≥ 2 prior treatment regimens. After FCA (F 30 mg/m 2 × 3d, C 0.5g/m 2 × 3d, A 20 mg/d × 3d) LD regimen, pts received a single infusion of UCART22-P2. In vitro comparability assays suggested that UCART22 P2 was more potent than UCART22 P1, so dose escalation with UCART22 P2 started at DL2 (1 x 10 6 cells/kg) compared to the highest studied dose DL3 (5 x 10 6 cells/kg) with UCART22 P1. Results: As of 01 July 2023, 3 pts were enrolled into the first UCART22 P2 cohort at DL2. Pt 1 is a 17yo female with B-ALL with a hypodiploid karyotype and a germline TP53 mutation whose disease had previously failed to respond to multiagent chemotherapy, blinatumomab (blina), inotuzumab (ino), venetoclax (ven), allogeneic hematopoietic stem cell transplantation (HSCT), and autologous CD19 CAR T-cell therapy (CAR19) x2. Pt 2 is a 68yo female with Ph-negative B-ALL who relapsed with CD19-low disease after multiagent chemotherapy, ino, and blina. Pt 3 is a 27yo male with B-ALL with an ABL2 fusion who had failed multiagent chemotherapy, ino, blina, TKIs, and an experimental autologous CAR19. UCART22 P2 administered after the FCA LD regimen was well tolerated. No DLTs or ICANS were observed. Cytokine release syndrome (CRS) occurred in 2/3 (67%) pts, with one G1 that resolved without treatment and one G2 that resolved after tocilizumab x1. There was one G5 sepsis SAE at D40 considered related to UCART22 P2 and FCA LD in Pt 1. Responses were assessed beginning on D28. Up to FC/FCA-DL3 with 18 pts treated with UCART22 P1, 1 CR, 4 CRi, and 2 morphologic leukemia-free states (MLFS) were observed, with 3 responses occurring out of 6 (50%) patients treated with FCA-DL3 (previously reported, EHA 2023). For UCART22 P2, FCA-DL2, 2/3 pts (67%) responded: Pt 2 achieved an MRD neg CR lasting over 84 days after UCART22 infusion; Pt 1 achieved an MRD negative MLFS up to D40. Pt 3 was refractory to treatment, however this pt received bridging therapy with dasatinib for his ABL2 fusion, and on Day -1, only 47% of the leukemic cells expressed CD22 (down from 88% at screening). UCART22 P2 expansion was observed by flow cytometry in peripheral blood with peak of 79 cells/μl in Pt 1 and 225 cells/μl in Pt 2, both at D11, with predominantly CD8 cells expanding. Inflammatory markers such as ferritin, IFN-γ, TNF-α and IL-6 levels increased more than 3-fold, correlating with UCART22 P2 expansion and CRS. Summary : In vitro comparability studies indicated that UCART22 P2 was more potent than UCART22 P1, and this was suggested clinically, as there was a 67% response rate at DL2 with UCART22 P2 compared to 50% at DL3 with UCART22 P1. Use of UCART22 P2 did not lead to any grade ≥3 CRS, and no DLTs or ICANS was observed. UCART22 P2 expansion was seen in the two responders, which closely correlated with CRS and changes in inflammatory markers. These data support the safety and preliminary efficacy of UCART22 P2 in this poor-risk R/R B-ALL population. The study continues to enroll pts treated with UCART22 P2 at dose level 2i (2.5 x 10 6 cells/kg), and updated data will be presented.

Multiplex Prime Editing and PASSIGE TM for Non-Viral Generation of an Allogeneic CAR-T Cell Product

While CAR-T cell therapy represents a major advance in personalized immunotherapy, the autologous nature of commercially available CAR-T products have delayed its broad application beyond a subset of hematological malignancies. In particular, manufacturing autologous CAR-T therapies is costly and time-consuming, and success relies on the fitness of a patient's cells. An allogeneic off-the-shelf CAR-T product could overcome these cell quality and quantity issues and could be accessed on-demand. However, a successful allogeneic CAR-T product will require multiplex gene knockout in addition to stable CAR integration to prevent graft-versus-host disease (GvHD) and graft rejection by the patient's immune system. Strategies for the delivery and expression of CAR transgenes include semi-random integration using lentivirus or transposons, which risk unintended gene disruption or activation. Targeted integration can be achieved using nucleases in combination with a template for homology-directed repair (HDR), but efficiency of this approach is generally low and there are risks associated with the induction of double-strand breaks (DSBs), including p53 activation and chromothripsis. This is further complicated in a situation where multiplex editing is required, as multiple DSBs can lead to gross chromosomal rearrangements. Alternatively, base editors have been used for targeted gene disruption without the induction of DSBs via single nucleotide conversion to disrupt a splice site or introduce a single premature stop (pmSTOP) codon. However, this approach is limited to transition mutations and cannot be used to integrate large genetic cargo, which is required to generate CAR-T cells. Prime Editing (PE) can be used for precise and programmable gene disruption via multiple strategies, including introduction of multiple pmSTOP codons, splice site disruption, frameshift mutations, or deletion of large segments of regulatory or coding sequence. Further, Prime-Assisted Site-Specific Integrase Gene Editing (PASSIGE) can be used to precisely and flexibly integrate large genetic cargo at a specific locus. Together, PE-mediated gene knock out and PASSIGE can be tailored to generate a more broadly applicable, potentially safer, and more effective CAR-T cell product. To evaluate the efficacy of an all-PE non-viral approach to allogeneic CAR-T cell generation, PASSIGE and PE mediated gene knockout were used to generate CD19-CAR-T cells. Multiplex PE precisely disrupted expression of the endogenous T cell receptor alpha constant ( TRAC) and beta-2-microglobulin ( B2M) loci in over 90% of human T cells. Co-delivery of a non-viral DNA donor template with PASSIGE editing components resulted in targeted integration of a 3.5 kb CD19-CAR transgene expression cassette at the TRAC locus in over 60% of the T cells, with no observed impact on T cell viability, phenotype, or functionality. CD19 CAR-T cells generated using PASSIGE show potent anti-tumor activity and cytokine production in response to CD19 + tumor cell lines in vitro and in vivo. The PASSIGE-generated CD19 CAR-T cells reduce tumor burden and prolong survival of mice bearing CD19 + tumors. These results show that a PE platform can be used to generate multiplex edited CAR-T cells without the need for viral vectors and without causing DSBs. This modular, one-step, non-viral delivery Prime Editing platform expands the applicability of T cell therapies for the treatment of tumors and immune diseases.

Phase 1/2 Dose-Escalation/Dose-Expansion Study of Anti-CD7 Allogeneic CAR-T Cells (WU-CART-007) in Relapsed or Refractory (R/R) T-Cell Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma (T-ALL/LBL)

T-ALL/LBL are challenging hematologic cancers with high rates of relapse and mortality in both children and adults. Despite success in B-cell malignancies, development of CAR-T cell therapy for T cell malignancies has been complicated by induction of fratricide and risk of malignant cell contamination of the drug product in the autologous setting. WU-CART-007 is a CD7-targeted CAR-T cell products with CRISPR/Cas9 deletion of CD7 and T-cell receptor alpha constant (TRAC), to prevent fratricide and enable the use of healthy donor allogeneic T-cells, respectively (Leedom et al. ASH 2021). This off-the-shelf allogeneic CAR-T cell product is being developed for the treatment of CD7 + malignancies. WU-CART-007 1001 (NCT04984356) is a global first-in-human, Phase 1/2 single-agent study of WU-CART-007 in patients (pts) with R/R T-ALL/LBL. The recommended Phase 2 dose (RP2D) of WU-CART-007 is 900 million (M) cells administered on day 1 following lymphodepleting chemotherapy (LDC). Two different LDC regimens have been tested: standard LDC (fludarabine 30 mg/m 2/day x 3 days and cyclophosphamide 500 mg/m 2/day x 3 days), and enhanced LDC (eLDC; fludarabine 30 mg/m2/day x 4 days and cyclophosphamide 1000 mg/m2/day x 3 days).Disease response is assessed by Day 28 bone marrow (BM) aspirate/biopsy, and CT/PET, if applicable, per NCCN Guidelines Version 2.2022; Pharmacokinetics (PK) are measured by ddPCR; samples are collected for immunophenotyping by flow cytometry (FACS). As of July 21, 2023, 18 pts have been dosed with WU-CART-007(n = 11 T-ALL, n = 7 T-LBL); 3 with 100M (DL1), 3 with 300M (DL2), 6 with 600M (DL3), and 6 with 900M (DL4/RP2D) cells in a single infusion. A total of 15 pts received standard LDC while 3 received eLDC at the DL4/RP2D. Median age is 33.5 years (range 20-68). Pts were heavily pretreated with a median of 4 prior lines of therapy (range 2 - 7), 28% (5/18) relapsed following an allogeneic HSCT. Disease burden at baseline consisted of extramedullary disease (EMD) in 28% (5/18) of pts, and a median BM blast count of 60% (range 5-98%) in pts with BM disease (13/18). Overall WU-CART-007 demonstrated manageable safety profile; treatment-related adverse events of ≥ G3 were observed in 8/18 (44%) pts. Cytokine release syndrome (CRS) was observed in 14/18 (78%) pts. Most (72%; 13/18) pts had G1-2 CRS events; a single G3 CRS event was reported which resolved within 72 hours after receiving tocilizumab, dexamethasone, and low-dose vasopressors. Grade 1 ICANS was reported in one patient at DL3, which resolved spontaneously. No GvHD, prolonged T-cell aplasia, or prolonged pancytopenia in the absence of disease were observed. One unrelated DLT lead to cohort expansion at DL3. The majority of deaths were due to disease progression. There were two Grade 5 events not attributed to WU-CART-007, both due to fungal infection. WU-CART-007 showed dose-dependent anti-tumor activity with no responses seen at DL1. In evaluable patients at DL≥ 2 (n=12) Composite Complete Remission Rate (CRc; CR + CRi + CRh): 58% (86% MRD neg), median duration of response 12.3 weeks (1.1 - 29.4); two patients successfully received a consolidating allogeneic-HSCT. At the RP2D, the CRc rate was 60% (3/5; 2 CR, 1CRi). Molecular expansions of CAR-T cells peaked on day 10 in peripheral blood (mean 66,069 copies/ug DNA) and persisted out to day 56. Of all pts tested (n=15), none developed novel anti-HLA antibodies against the donor, and no anti-drug antibodies against the CAR-construct were detected. Phenotypic analysis revealed in vivo WU-CART-007 cells expressed activation markers (KI67, CD38, HLA-DR) and were largely an effector memory CD45RA + (EMRA) CM phenotype (CD45RA +, CD197 +). WU-CART-007 has demonstrated an acceptable safety profile and preliminary evidence of anti-leukemic activity. This program advances CAR-T cell therapy in heavily pre-treated patients with R/R T-ALL/LBL. Enrollment is ongoing.

Inserting EF1α-driven CD7-specific CAR at CD7 locus reduces fratricide and enhances tumor rejection.

CAR-T therapies to treat T-cell malignancies face unique hurdles. Normal and malignant T cells usually express the same target for CAR, leading to fratricide. CAR-T cells targeting CD7, which is expressed in various malignant T cells, have limited expansion due to fratricide. Using CRISPR/Cas9 to knockout CD7 can reduce the fratricide. Here we developed a 2-in-1 strategy to insert EF1α-driven CD7-specific CAR at the disrupted CD7 locus and compared it to two other known strategies: one was random integration of CAR by a retrovirus and the other was site-specific integration at T-cell receptor alpha constant (TRAC) locus, both in the context of CD7 disruption. All three types of CD7 CAR-T cells with reduced fratricide could expand well and displayed potent cytotoxicity to both CD7+ tumor cell lines and patient-derived primary tumors. Moreover, EF1α-driven CAR expressed at the CD7 locus enhances tumor rejection in a mouse xenograft model of T-cell acute lymphoblastic leukemia (T-ALL), suggesting great clinical application potential. Additionally, this 2-in-1 strategy was adopted to generate CD7-specific CAR-NK cells as NK also expresses CD7, which would prevent contamination from malignant cells. Thus, our synchronized antigen-knockout CAR-knockin strategy could reduce the fratricide and enhance anti-tumor activity, advancing clinical CAR-T treatment of T-cell malignancies.

Homology-independent targeted insertion (HITI) enables guided CAR knock-in and efficient clinical scale CAR-T cell manufacturing

BackgroundChimeric Antigen Receptor (CAR) T cells are now standard of care (SOC) for some patients with B cell and plasma cell malignancies and could disrupt the therapeutic landscape of solid tumors. However, access to CAR-T cells is not adequate to meet clinical needs, in part due to high cost and long lead times for manufacturing clinical grade virus. Non-viral site directed CAR integration can be accomplished using CRISPR/Cas9 and double-stranded DNA (dsDNA) or single-stranded DNA (ssDNA) via homology-directed repair (HDR), however yields with this approach have been limiting for clinical application (dsDNA) or access to large yields sufficient to meet the manufacturing demands outside early phase clinical trials is limited (ssDNA).MethodsWe applied homology-independent targeted insertion (HITI) or HDR using CRISPR/Cas9 and nanoplasmid DNA to insert an anti-GD2 CAR into the T cell receptor alpha constant (TRAC) locus and compared both targeted insertion strategies in our system. Next, we optimized post-HITI CRISPR EnrichMENT (CEMENT) to seamlessly integrate it into a 14-day process and compared our knock-in with viral transduced anti-GD2 CAR-T cells. Finally, we explored the off-target genomic toxicity of our genomic engineering approach.ResultsHere, we show that site directed CAR integration utilizing nanoplasmid DNA delivered via HITI provides high cell yields and highly functional cells. CEMENT enriched CAR T cells to approximately 80% purity, resulting in therapeutically relevant dose ranges of 5.5 × 108–3.6 × 109 CAR + T cells. CRISPR knock-in CAR-T cells were functionally comparable with viral transduced anti-GD2 CAR-T cells and did not show any evidence of off-target genomic toxicity.ConclusionsOur work provides a novel platform to perform guided CAR insertion into primary human T-cells using nanoplasmid DNA and holds the potential to increase access to CAR-T cell therapies.

Antibody-based binding domain fused to TCRγ chain facilitates T cell cytotoxicity for potent anti-tumor response

Chimeric antigen receptor T-cell (CAR-T) therapy has demonstrated potent clinical efficacy in the treatment of hematopoietic malignancies. However, the application of CAR-T in solid tumors has been limited due in part to the expression of inhibitory molecules in the tumor microenvironment, leading to T-cell exhaustion. To overcome this limitation, we have developed a synthetic T-cell receptor (TCR) that targets programmed death-ligand 1 (PD-L1), a molecule that is widely expressed in various solid tumors and plays a pivotal role in T-cell exhaustion. Our novel TCR platform is based on antibody-based binding domain, which is typically a single-chain variable fragment (scFv), fused to the γδ TCRs (TCRγδ). We have utilized the T-cell receptor alpha constant (TRAC) locus editing approach to express cell surface scFv of anti-PD-L1, which is fused to the constant region of the TCRγ or TCRδ chain in activated T cells derived from peripheral blood mononuclear cells (PBMCs). Our results indicate that these reconfigured receptors, both γ-TCRγδ and δ-TCRγδ, have the capability to transduce signals, produce inflammatory cytokines, degranulate and exert tumor killing activity upon engagement with PD-L1 antigen in vitro. Additionally, we have also shown that γ-TCRγδ exerted superior efficacy than δ-TCRγδ in in vivo xenograft model.

Combining different CRISPR nucleases for simultaneous knock-in and base editing prevents translocations in multiplex-edited CAR T cells

BackgroundMultiple genetic modifications may be required to develop potent off-the-shelf chimeric antigen receptor (CAR) T cell therapies. Conventional CRISPR-Cas nucleases install sequence-specific DNA double-strand breaks (DSBs), enabling gene knock-out or targeted transgene knock-in. However, simultaneous DSBs provoke a high rate of genomic rearrangements which may impede the safety of the edited cells.ResultsHere, we combine a non-viral CRISPR-Cas9 nuclease-assisted knock-in and Cas9-derived base editing technology for DSB free knock-outs within a single intervention. We demonstrate efficient insertion of a CAR into the T cell receptor alpha constant (TRAC) gene, along with two knock-outs that silence major histocompatibility complexes (MHC) class I and II expression. This approach reduces translocations to 1.4% of edited cells. Small insertions and deletions at the base editing target sites indicate guide RNA exchange between the editors. This is overcome by using CRISPR enzymes of distinct evolutionary origins. Combining Cas12a Ultra for CAR knock-in and a Cas9-derived base editor enables the efficient generation of triple-edited CAR T cells with a translocation frequency comparable to unedited T cells. Resulting TCR- and MHC-negative CAR T cells resist allogeneic T cell targeting in vitro.ConclusionsWe outline a solution for non-viral CAR gene transfer and efficient gene silencing using different CRISPR enzymes for knock-in and base editing to prevent translocations. This single-step procedure may enable safer multiplex-edited cell products and demonstrates a path towards off-the-shelf CAR therapeutics.

Effective Cell Dose and Functional Attributes of Azercabtagene Zapreleucel (azer-cel; PBCAR0191) Associate with Allogeneic CAR T-Cell Safety and Efficacy in Patients with Relapsed/Refractory B-Cell Lymphoma

Background: Characterization of product cellular attributes contributing to the in vivo expansion and toxicity of allogeneic, CD19-directed chimeric antigen receptor (CAR) T-cell therapy is necessary to optimize efficacy and safety. Using a single step process, the azer-cel CD19 CAR is knocked into the T-cell receptor alpha constant (TRAC) gene locus via a TRAC-specific ARCUS nuclease in activated T cells. Unlike autologous CAR T-cell therapy, all allogeneic CAR T products are cryopreserved. In this phase I study of the allogeneic, CD19-directed CAR T azer-cel, we analyzed post-thaw product attributes and cell composition of the infused product associated with pharmacokinetics (PK), pharmacodynamics (PD), and clinical outcomes (NCT03666000). Methods: Azer-cel was administered as a single infusion to 44 subjects across several dose levels and fludarabine/cyclophosphamide lymphodepletion regimens. CAR T cell peak expansion (Cmax), PK and area under the concentration-time curve (AUC) was assessed by flow cytometry and PD by multiplex cytokine assays. Azer-cel post-thaw cell composition was assessed by flow cytometry (minimally differentiated stem central memory [SCM], CC-chemokine receptor 7 (CCR7)+; differentiated effector memory, CCR7-). Effective cell number infused for any antigenically defined population was estimated using the product of the population percentage and the total post-thaw viable cell number. Overall tumor burden was measured as sum of the products of perpendicular diameters of target lesions and response was evaluated using Lugano 2016 criteria. Responders had either a complete or partial response at Day 28 or later. Relationships to safety events and efficacy were assessed using univariate correlative analyses (variables selected based on Pearson correlation coefficients ρ(rho)>0.35 unless specified, P-value <0.05). Results: Peak azer-cel levels and AUC varied by dose level with median Cmax ranging from 38 cells/mL at DL2 to 6.7x 104 cells/mL at DL4b, whereas median AUC0-28 ranged between 3 x 102 to 5.1x 105(cells/mL*days). Both azer-cel Cmax and AUC correlated strongly with SCM cell dose (P=0.009 & P=0.0026, respectively). Development of cytokine release syndrome (CRS) associated with effective SCM CD8+ cell dose (P<0.05) and total tumor burden (P=0.0087), in addition to Cmax of the cytokines interleukin (IL)-6, TNFα, MIP1α, IL-10 and C-X-C motif chemokine ligand 10 (CXCL10) or Interferon gamma-induced protein 10 (IP10) (P<0.01). Immune effector cell-associated neurotoxicity syndrome (ICANS) correlated with azer-cel Cmax (P=0.035), AUC (P=0.0057), total tumor burden (P=0.004), and effective SCM CAR T cell dose (P<0.05), as well as changes in a distinct set of cytokines that included IL-2, IL-8, IIL-15, IL-6, and IP10 (P<0.05). Grade >3 ICANS correlated strongly with effective SCM CD4+ cell dose (P=0.0015), differentiated CD4+CCR7- cell dose (ρ =0.34, P=0.029) and CD4:CD8 ratio (ρ = 0.32, P= 0.036), in addition to Cmax of IL-6, IL-2 and IP10 (P< 0.01). Overall response to azer-cel treatment negatively correlated with differentiated CD4+ CCR7- cell dose (P=0.04). Conclusions: Post-thaw product composition and effective cell dose are predictive for in vivo expansion potential, CAR-T-related adverse events and response to treatment with azer-cel. This is the first analysis of an allogeneic CD19 CAR T product composition to demonstrate that strategies intended to maximize stem central memory T-cell fraction (CCR7+) while limiting CD4+ CCR7- differentiated fraction may improve safety and efficacy of CAR T therapy.

Ameli-01: A Phase I Trial of UCART123v1.2, an Anti-CD123 Allogeneic CAR-T Cell Product, in Adult Patients with Relapsed or Refractory (R/R) CD123+ Acute Myeloid Leukemia (AML)

Introduction: UCART123v1.2 is a genetically modified allogeneic T-cell product manufactured from healthy donor cells. Donor-derived T-cells are transduced using a lentiviral vector to express the anti-CD123 chimeric antigen receptor and are further modified using Cellectis' TALEN® technology to disrupt the T-cell receptor alpha constant (TRAC) and CD52 genes to minimize risk of graft-vs-host disease (GvHD) and allow use of anti-CD52-directed therapy as part of lymphodepletion (LD). AMELI-01 (NCT04106076) is a phase 1, open-label, dose-escalation trial evaluating the safety, tolerability, expansion, and persistence of UCART123v1.2 given at escalating dose levels after LD with either fludarabine and cyclophosphamide (FC) or FC with alemtuzumab (FCA) in patients (pts) with R/R CD123+ AML. Alemtuzumab was added to the LD regimen to sustain host T- and NK-cell depletion and to promote UCART123v1.2-cell expansion and persistence. Methods: Key eligibility criteria include pts 18-65 yrs, adequate organ function, ECOG PS ≤ 1, and blasts positive for CD123 by flow cytometry. Pts must have received ≥2 cycles of chemotherapy (one with standard dose cytarabine), ≥ 1 cycle of a high/intermediate dose cytarabine containing regimen, ≥ 2 cycles of an HMA combination regimen, or prior allogeneic HSCT. After LD with FC or FCA, pts received UCART123v1.2 at one of the following dose levels: 2.5x105 cells/kg (DL1); 6.25x105 cells/kg (DL2); 1.5x106 cells/kg (DL2i); or 3.03x106 cells/kg (DL3). The primary endpoint is the safety, tolerability, and MTD/RP2D of UCART123v1.2. DLTs are assessed over a 28d observation period after UCART123v1.2 infusion. Additional endpoints include investigator assessed anti-leukemic activity per 2017 ELN criteria, and expansion, trafficking, and persistence of UCART123v1.2 (assessed in peripheral blood [PB] and bone marrow [BM] by flow cytometry and vector copy number [VCN]). Measurable residual disease (MRD) was analyzed by local multiparameter flow cytometry with a sensitivity of 0.02%. Results: As of July 1, 2022, 16 pts received LD and UCART123v1.2; 8 pts received UCART123v1.2 after FC (DL1 [n=2]; DL2 [n=3]; DL2i [n=2]; DL3 [n=1]), and 8 pts received UCART123v1.2 after FCA (DL2). Pts were high risk and heavily pretreated with disease characteristics outlined in Table 1. Median baseline BM and PB % blasts was 37% (0-88%) and 19% (0-79%), and median baseline CD123 positivity by central flow cytometry in the FC and FCA arms was 82% (17-98%) and 84% (25-97%), respectively. Four pts experienced DLTs: 3 pts in FC arm (G4 CRS [1pt in DL2i and 1pt in DL3] and G3 ICANS [1pt in DL2i]); and 1 pt in FCA arm (G5 CRS in DL2). Cytokine release syndrome (CRS) occurred in 15/16 pts (FC arm [n=7]; FCA arm [n=8]), of which 3 pts experienced ≥ G3 CRS which were classified as DLTs as noted above (FC arm G4 [n=2]; FCA arm G5 [n=1]). Responses were assessed beginning on D28. Evidence of UCART123v1.2 activity was observed in 4/16 pts with best overall responses as follows: FC arm (DL2: 1 SD; DL2i: 1 MLFS); FCA arm (DL2: 1 SD and 1 MRD-negative CR). The pt in the DL2 FCA arm with SD achieved greater than 90% BM blast reduction (60% to 5%) at D28. The pt with CR, who had failed 5 prior lines of therapy including HSCT and had baseline G4 cytopenias, had CRi at D28 with full count recovery at D56 and remains in an MRD-negative CR beyond the 8-month f/u visit. Adequate lymphodepletion was not achieved in the FC arm, as host lymphocyte recovery was observed in 7/8 pts prior to D28, and only 3/8 pts had UCART123v1.2 expansion (Cmax ranged from 3,757 to 27,828 copies/μg DNA). In contrast, FCA LD resulted in robust lymphodepletion for greater than 28 days in all pts, and 6/8 demonstrated UCART123v1.2 expansion, with Cmax ranging from 13,177 to 330,530 copies/μg DNA, an almost 9-fold increase compared with FC LD. An increase in inflammatory markers, notably serum ferritin, and serum cytokines (including IL-2, IL-6, IL-10, IL-15, IFN-γ, and TNF-α) in the FCA arm correlated with both UCART123v1.2 expansion and CRS. Conclusions: Adding alemtuzumab to the FC regimen was associated with improved LD and significantly higher UCART123v1.2 cell expansion and persistence, which correlated with improved activity and safety, including one pt in the DL2 FCA arm who achieved a durable MRD-negative CR. Overall, these data support the safety and activity of UCART123v1.2 after FCA LD in pts with CD123+ R/R AML. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

ALL-IN-ONE VIRUS-FREE MANUFACTURING PROCESS OF ALLOGENEIC CHIMERIC ANTIGEN RECEPTOR (CAR) T CELLS USING CRISPR/CAS9

Chimeric antigen receptor (CAR) T cell therapy has emerged as a promising therapeutic opportunity against blood cancers, leading to the six FDA-approved CAR T cell products. All commercially available products are produced following an autologous strategy, which represents a bottleneck for the widespread adoption of this technology due to the poor quality and quantity of patients’ T cells. Allogeneic T cells from healthy donors are an excellent alternative over the autologous ones, allowing the production of a ready-to-use therapy besides additional benefits, such as standardization of the final product, cost reduction through manufacturing scale-up, and the possibility of multiple genetic modifications. Safety concerns related to the use of cells from third-party donors can be easily eliminated through T cell receptor (TCR) knock-out with the demonstrated prevention of graft-versus-host disease development. Here we describe CRISPR/Cas9 editing for TRAC ( T Cell Receptor Alpha Constant )-targeted genomic integration of the CAR transgene and the consequent TCR knock-out in a fast and efficient virus-free manufacturing process. For the CRISPR/Cas9-mediated knock-in, we designed a plasmid containing the second-generation anti-CD19 CAR flanked by arms homologous to the desired cut site. This sequence was PCR amplified and purified, resulting in a highly concentrated double-stranded DNA (dsDNA) template for the homology-directed repair (HDR). Human T cells isolated from healthy donors were electroporated with the dsDNA-HDR templates (dsDNA-HDRT) and Cas9 ribonucleoproteins (RNPs) targeting the human TRAC locus. Cells were assayed on days 5 and 11 post-electroporation for CAR expression and killing efficiency, respectively. A mCherry transgene flanked by the same homology arms was also included as a control. Preliminary studies using the mCherry dsDNA-HDRT indicated a 1.2-fold improvement in the editing efficiency by adding the positively charged polymer poly-L-glutamic acid (40 μg) that binds to RNPs and reduces aggregates. Additionally, by culturing the electroporated cells with varying concentrations of an NHEJ inhibitor, we observed a 1.4 to 2-fold increase in mCherry knock-in, suggesting a favorable condition for the HDR. Based on the established optimized conditions, we electroporated T cells with the CAR dsDNA-HDRT (3.1 kb length, 6 μg) and got 88% of CAR+ cells five days after electroporation. The viability was 27% on day 3 and reached about 60% on day 7. On-target CAR gene integration was confirmed through an “in-out” PCR assay on the genomic DNA using primers specific to the TRAC locus and CAR transmembrane domain. We then analyzed the in vitro cytotoxicity of CAR T cells by coculturing them with GFP-expressing tumor cell lines. Complete growth inhibition of the RS4-11 cells (CD19 + ) was achieved at the 5:1, 10:1, and 50:1 effector-to-target ratios. For the K562 cells (CD19-), conversely, the killing activity was related to the T cells themselves since CAR expression did not further decrease the tumor cell number. These results demonstrate robust cytotoxic function and target specificity of the CAR T cell products. Combined, the data provide a proof-of-concept for the virus-free manufacturing process of allogeneic anti-CD19 CAR T cells, enabling CAR knock-in and TCR knock-out in an all-in-one strategy.

Pharmacological interventions enhance virus-free generation of TRAC-replaced CAR T cells

Chimeric antigen receptor (CAR) redirected T cells are potent therapeutic options against hematological malignancies. The current dominant manufacturing approach for CAR T cells depends on retroviral transduction. With the advent of gene editing, insertion of a CD19-CAR into the T cell receptor (TCR) alpha constant (TRAC) locus using adeno-associated viruses for gene transfer was demonstrated, and these CD19-CAR T cells showed improved functionality over their retrovirally transduced counterparts. However, clinical-grade production of viruses is complex and associated with extensive costs. Here, we optimized a virus-free genome-editing method for efficient CAR insertion into the TRAC locus of primary human T cells via nuclease-assisted homology-directed repair (HDR) using CRISPR-Cas and double-stranded template DNA (dsDNA). We evaluated DNA-sensor inhibition and HDR enhancement as two pharmacological interventions to improve cell viability and relative CAR knockin rates, respectively. While the toxicity of transfected dsDNA was not fully prevented, the combination of both interventions significantly increased CAR knockin rates and CAR T cell yield. Resulting TRAC-replaced CD19-CAR T cells showed antigen-specific cytotoxicity and cytokine production in vitro and slowed leukemia progression in a xenograft mouse model. Amplicon sequencing did not reveal significant indel formation at potential off-target sites with or without exposure to DNA-repair-modulating small molecules. With TRAC-integrated CAR+ T cell frequencies exceeding 50%, this study opens new perspectives to exploit pharmacological interventions to improve non-viral gene editing in T cells.

Characterization of WU-CART-007, an Allogeneic CD7-Targeted CAR-T Cell Therapy for T-Cell Malignancies

BackgroundT-cell Acute Lymphoblastic Leukemia (T-ALL) / Lymphoblastic Lymphoma (LBL) represent a class of devastating hematologic cancers with high rates of relapse and mortality in both children and adults. Development of CAR-T cell therapies for T-cell cancers has been complicated by induction of fratricide and the high risk of malignant cell contamination of the drug product in the autologous setting. Previously, Cooper et. al., demonstrated that CRISPR/Cas9 gene-editing to delete CD7 prevented self-killing, and deletion of the T-cell receptor alpha constant (TRAC) enabled the use of healthy donor-derived T-cells to manufacture CD7-targeted CAR-T cells without risk of malignancy and mitigating the risk of GvHD. Here we present preclinical data supporting the safety and efficacy of WU-CART-007, an IND ready, off-the-shelf, and fratricide resistant CD7-targeted CAR-T cell for the treatment of CD7+ T-cell malignancies.MethodsWU-CART-007 was manufactured using T cells isolated from healthy donors by deletion of CD7 and TRAC, followed by CAR transduction, cell expansion, depletion of residual TCRa/b+ cells and cryopreservation. Donors were confirmed negative for a panel of adventitious viruses. CD7/TRAC deletion and CAR transduction were confirmed by flow cytometry. Off-target editing profile was assessed by GUIDE-Seq. The binding kinetics to human CD7 were conducted by bio-layer interferometry and CD7 selectivity was confirmed by cell microarray with a library of HEK-293 cells expressing approximately 6000 human proteins. The in vitro activity of WU-CART-007 was interrogated by co-culture with human CD7+ CCRF-CEM T-ALL cells and the potential on-target, off-tumor activity was assessed by co-culture with a panel of immune and non-immune primary human cells. In vivo anti-tumor functionality was confirmed in immunocompromised NSG mice after the establishment of low or high tumor burden CCRF-CEM xenografts engineered to express green fluorescent protein (GFP) and click beetle red (CBR) luciferase. The impact of WU-CART-007 on normal hematopoiesis was assessed using CD34+ humanized NCG mice.ResultsSeveral successful full-scale manufacturing runs were completed with consistently high dual CD7/TRAC deletion, transduction efficiency, and cell viability. Drug product was primarily composed of a T cell memory phenotype. Off- target nuclease analysis by GUIDE-seq and targeted NGS confirmed no evidence of off-target editing events. The WU-CART-007 scFv exhibited high affinity and exquisite specificity for human CD7. In vitro co-incubation experiments confirmed strong cytotoxicity against CD7-expressing cells including CCRF-CEM T-ALL cells, primary T and NK cells, but not CD7- cells such as myeloid cells, B cells, hepatocytes, astrocytes, cardiomyocytes, epithelial cells, and endothelial cells. Importantly, no cytotoxicity was observed against hematopoietic progenitor cells in human bone marrow or cord blood following co-incubation with WU-CART-007. Similarly, WU-CART-007 treatment of a non-tumor bearing humanized mouse model resulted in transient reductions in CD7+ cells (T-cells and NK cells) but not CD7- cells (myeloid and B cells), and the impacted cells recovered after circulating WU-CART-007 cells were no longer detectable. Assessment of in vivo anti-tumor efficacy revealed that WU-CART-007 effectively inhibited tumor progression (>99% TGI) in both low and high burden CCRF-CEM tumor models and improved survival in a dose-dependent manner, while CAR- cells were inactive, confirming CD7-dependent activity.ConclusionsThese preclinical studies support the use of WU-CART-007 in clinical trials and highlight the potential of WU-CART-007 to be a well-tolerated and active therapy for patients with CD7+ T-cell malignancies. A first in human Phase 1/2 trial in patients with R/R T-ALL/LBL is currently open for enrollment (NCT# 04984356). DisclosuresNo relevant conflicts of interest to declare.

Allogeneic CAR-T PBCAR0191 with Intensified Lymphodepletion Is Highly Active in Patients with Relapsed/Refractory B-Cell Malignancies

Allogeneic CAR-T PBCAR0191 with Intensified Lymphodepletion Is Highly Active in Patients with Relapsed/Refractory B-Cell Malignancies

Preliminary Results from the Flu/Cy/Alemtuzumab Arm of the Phase I BALLI-01 Trial of UCART22, an Anti-CD22 Allogeneic CAR-T Cell Product, in Adult Patients with Relapsed or Refractory (R/R) CD22+ B-Cell Acute Lymphoblastic Leukemia (B-ALL)

Preliminary Results from the Flu/Cy/Alemtuzumab Arm of the Phase I BALLI-01 Trial of UCART22, an Anti-CD22 Allogeneic CAR-T Cell Product, in Adult Patients with Relapsed or Refractory (R/R) CD22+ B-Cell Acute Lymphoblastic Leukemia (B-ALL)

Clinical Manufacture of FT819: Use of a Clonal Multiplexed-Engineered Master Induced Pluripotent Stem Cell Line to Mass Produce Off-the-Shelf CAR T-Cell Therapy

FT819 is a first-of-kind, allogeneic, off-the-shelf CAR T-cell therapy derived from a clonal master induced pluripotent stem cell (iPSC) line precisely engineered to insert a novel 1XX anti-CD19 chimeric antigen receptor (CAR) under the regulation of the T-cell receptor alpha constant (TRAC) locus for optimized control of anti-tumor activity and to completely delete T-cell receptor (TCR) expression to eliminate the potential of graft-versus-host disease (GvHD). Unlike conventional allogeneic CAR T-cell therapies which require repeatedly sourcing of T cells from various donors as the starting material, the use of a clonal master engineered iPSC line serves as a renewable starting cell source and ensures routine mass production of a uniformly engineered, homogenous CAR T-cell product for broad patient access.T cell-derived iPSCs were generated using a proprietary non-integrating cellular reprogramming system and genetically modified to integrate a novel anti-CD19 1XX CAR into both alleles of the TRAC gene. After single cell subcloning, each engineered iPSC clone was screened for multiple critical quality attributes including pluripotency, identity, genomic stability, cassette integration, on/off-target integration, T-cell differentiation propensity, and CAR T-cell function. Accordingly, the ideal single cell-derived engineered iPSC clone was selected as the clonal master iPSC line for FT819 and was converted into a master cell bank (MCB).The iPSC MCB serves as a renewable source for the routine GMP manufacture of FT819 drug product. The FT819 production process consists of three stages: 1) generation of CD34-expressing hematopoietic progenitor cells from iPSCs (>90% CD34+ cells post enrichment); 2) lineage-specification to T cells followed by T-cell expansion (>5e5 fold expansion); and 3) fill/finish and cryopreservation of the drug product. As an example, in an initial small-scale manufacturing campaign, a total of 2.5 × 10 10 FT819 CAR T-cells were generated and filled and finished starting from one vial of the MCB.The FT819 drug product was tested on safety, identity, purity, and potency. The final product was comprised of CD45+CD7+ lymphocytes (>99%), with homogeneous CAR expression (>99% CAR+) and lacking expression of TCRαβ (not detected) on the cell surface. Importantly, there were no residual iPSCs detected in the FT819 drug product. The FT819 drug product exhibited potent and consistent effector function against NALM6 leukemia cells. The FT819 drug product is currently being used in a landmark Phase I study (NCT04629729), the first-ever iPSC-derived T-cell therapy to undergo clinical investigation, for the treatment of patients with relapsed/refractory B-cell lymphoma, chronic lymphocytic leukemia and precursor B-cell acute lymphoblastic leukemia.In summary, FT819 is a first-of-kind, off-the-shelf, CAR T-cell therapy uniquely derived from a clonal multiplexed-engineered master iPSC line. The novel manufacturing paradigm enables mass production of a uniformly engineered, homogenous cell therapy product that is available on-demand for broad patient access. A multi-center Phase 1 study of FT819 is currently ongoing for the treatment of B-cell malignancies.Key Words: cancer immunotherapy, cell therapy, CAR-T, CD19, allogeneic, induced pluripotent stem cell, iPSC, clonal master iPSC line, engineered, off-the-shelf, cGMP, production, manufacturing, FT819 DisclosuresYuan: Fate Therapeutics, Inc.: Current Employment. Clarke: Fate Therapeutics, Inc.: Current Employment. Lai: Fate Therapeutics, Inc.: Current Employment. Chang: Fate Therapeutics, Inc.: Current Employment. Yang: Fate Therapeutics, Inc.: Current Employment. Hsia: Fate Therapeutics, Inc.: Current Employment. Abujarour: Fate Therapeutics, Inc.: Current Employment. Lee: Fate Therapeutics, Inc.: Current Employment. van der Stegen: Fate Therapeutics, Inc.: Current Employment. Shaked: Fate Therapeutics, Inc.: Current Employment. Jalloh: Fate Therapeutics, Inc.: Current Employment. Moreno: Fate Therapeutics, Inc.: Current Employment. ORourke: Fate Therapeutics, Inc.: Current Employment. Sung: Fate Therapeutics, Inc.: Current Employment. Gutierrez: Fate Therapeutics, Inc.: Current Employment. Rezner: Fate Therapeutics, Inc.: Current Employment. Eberhart: Fate Therapeutics, Inc.: Current Employment. Magdaleno: Fate Therapeutics, Inc.: Current Employment. Farnan: Fate Therapeutics, Inc.: Current Employment. Plavsic: Fate Therapeutics, Inc.: Current Employment. Bressi: Fate Therapeutics, Inc.: Current Employment. Rivière: Centre for Commercialization of Cancer Immunotherapy: Other: Provision of Services; Fate Therapeutics: Other: Provision of Services, Patents & Royalties; The Georgia Tech Research Corporation (GTRC): Other: Provision of Services (uncompensated); FloDesign Sonics: Other: Provision of Services; Juno Therapeutics: Patents & Royalties. Valamehr: Fate Therapeutics, Inc.: Current Employment.

ESTABLISHMENT OF A CRISPR/CAS9-BASED GENOME EDITING PLATFORM FOR THE GENERATION OF AN OFF-THE-SHELF ALLOGENEIC CAR-T CELL MODEL

Chimeric antigen receptor (CAR)-T cell therapy has a remarkable clinical success. However, its autologous nature reduces accessibility to the therapy. Thus, one of the next frontiers in the field is to develop an allogeneic, ‘off-the-shelf'therapy. This can be achieved by knocking out the T cell receptor (TCR) from CAR-T cells using genome-editing tools to prevent the development of graft versus host disease. In addition, depletion of the human leukocyte antigen I (HLA-I) on the surface of CAR-T cells would dramatically reduce the chance of CAR-T cell rejection by the host immune system. Establish a methodology to produce TCR − and HLA-I − CAR-T cell models by knocking out the TRAC (T Cell Receptor Alpha Constant) and B2M (Beta-2-Microglobulin) genes, respectively, using CRISPR/Cas9 genome editing. We tested four guide RNAs (gRNAs) sequences, two against the TRAC gene (TRAC1 and TRAC2) and other two against the B2M gene (B2M1 and B2M2). The gRNAs sequences were cloned individually into lentiviral vectors upstream the anti-CD19 CAR gene, and the corresponding lentiviral particles were used to transduce Jurkat cells. We used these cells as a model for TCR and HLA depletion after the electroporation of a plasmid for a high-fidelity Cas9 transient expression. After transduction, CAR + Jurkat cells were enriched by magnetic selection to obtain homogeneous expression of CAR and gRNAs. We achieved above to 94% of CAR expressing cells for all populations. Next, TRAC/CAR + cells were electroporated with a plasmid encoding Cas9 and GFP using two different media: Solution V and Opti-MEM. After 24h of electroporation in Solution V, Jurkat cells displayed high viability (̃90%) regardless of the presence of Cas9-GFP plasmid. In Opti-MEM medium, however, electroporation induced high rates of cell death (12.1-16.0% viability). Furthermore, the frequency of GFP + cells after electroporation in Opti-MEM was 1.6-fold (TRAC1) and 1.9-fold (TRAC2) lower compared to Solution V. To evaluate the efficiency of TRAC gRNAs in depleting the TCR, electroporated cells in Solution V were analyzed after 1, 3 and 8 days for CD3 expression. Notably, TRAC gRNA 1 led to a remarkable reduction in the frequency of CD3 + cells (from 91.6 to 7.41%). In contrast, this reduction was less pronounced for TRAC gRNA 2 (decrease of 21.8%). For the B2M gRNAs analysis, we electroporated the corresponding Jurkat cells in Solution V and observed similar transfection efficiency compared to TRAC/CAR + cells in the same media (60% of GFP + cells). In addition, the B2M gRNAs efficiency was evaluated by HLA-I immunolabeling, and we observed a change in the frequency of HLA-I + cells only for the gRNA 2, with a reduction of 51.9% 8 days post electroporation. Finally, we confirmed the superior editing performance of TRAC1 and B2M2 gRNAs through the T7 endonuclease 1 assay. These data demonstrate the feasibility of TCR and HLA-I depletion by knocking out the TRAC and B2M genes using CRISPR/Cas9 and establish the best gRNA sequences for this purpose, paving the groundwork for the generation of a platform to produce off-the-shelf allogeneic CAR-T cells. FAPESP (2013/08135-2, 2019/18672-1, 2019/18702-8 and 2020/02043-2) and CNPq (442484/2020-8).

Abstract 332: Chimeric fusion receptors provide a CD3-mediated activation signal to off-the-shelf iPSC-derived TCR-less CAR-T cells for enhanced efficacy

Abstract T cells require a combination of signals to properly activate and exhibit their full potential; signal 1 from the T cell receptor (TCR), signal 2 from costimulatory receptors and signal 3 from cytokine receptors can shape the function of T cells. Second generation chimeric antigen receptor (CAR) T-cells targeting CD19 have shown success in hematologic malignancies, in part because signals 1 and 2 are provided by the CAR endodomain. As previously reported, we have developed an off-the-shelf iPSC-derived CAR19 T (CAR19-iT) cell product where the CAR is inserted into the T cell receptor alpha constant (TRAC) locus for enhanced efficacy and disruption of surface TCR expression. While the TCR-less CAR19-iT cells are ideal for allogeneic CAR-T cell therapies, as a consequence, they lack CD3 surface expression and the means by which to mediate CD3 signaling. To further improve CAR-iT cell performance and facilitate combinatorial strategies with T cell engagers such as bispecific T cell engagers (BiTEs), we designed chimeric fusion receptors (CFRs) comprising an ectodomain of CD3 or CD28, a transmembrane domain of CD28, and various endodomains that provide combinations of signals 1, 2, and 3. In addition to providing co-stimulatory signaling, the CFR designs can be controlled via agonistic antibodies or BiTEs to initiate signal transduction for precision control of the cell product. Furthermore, a series of CFRs with various CD3 endodomains were also developed to augment costimulatory signaling and the ER retention and endocytosis motifs found in CD3 endodomains were mutated to prevent downregulation of the CFRs from the cell surface of TCR-less cells. Selected CFRs were engineered into TRAC knockout Jurkat cells expressing a luciferase based NFAT reporter gene. After 48 hours, surface expression of the CFRs was confirmed by flow cytometry. Signal transduction via the CFRs was evaluated following exposure to agonistic antibodies or BiTEs. Measurement of the luciferase activity showed comparable levels to activated wildtype reporter cells. After construct validation, the CFRs were introduced into TCR-less CAR19-iT cells and co-cultured overnight with Nalm6 target cells in the presence of agonistic antibodies. Compared to control CAR19-iT cells, the armed CFR-CAR19 iT cells demonstrated superior killing of target cells. These results support the notion that enhancing signal 1 can increase CAR-T cell efficacy with current studies underway to investigate CFRs with endodomains that provide additional signal 2 or 3. We expect these constructs to further enhance CAR-iT cell persistence and engagement with BiTEs for activation and multi-antigen targeting. Collectively, the data suggest that TRC-less CAR-iT cells can be further armed with CFRs containing appropriate endodomains to provide superior antitumor function in a regulated manner. Citation Format: Eigen Peralta, Dan Lu, Mark Landon, Helen Chu, Shohreh Sikaroodi, Emily Carron, Natalie Navarrete, Alec Witty, Tom Lee, Anhco Nguyen, Bahram Valamehr. Chimeric fusion receptors provide a CD3-mediated activation signal to off-the-shelf iPSC-derived TCR-less CAR-T cells for enhanced efficacy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 332.

Preliminary Results of UCART19, an Allogeneic Anti-CD19 CAR T-Cell Product in a First-in-Human Trial (PALL) in Pediatric Patients with CD19+ Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia

▪BackgroundUCART19 is a genetically modified T-cell product manufactured from non-HLA matched healthy donor cells and aims to provide a ready to use, off-the-shelf allogeneic engineered CAR T-cell product. Lentiviral-transduced CAR T-cells express (1) an anti-CD19 CAR (anti-CD19 scFv- 41BB- CD3ζ), and (2) an RQR8 “safety switch” that is intended to allow targeted elimination of RQR8+ cells by rituximab. UCART19 has been additionally modified to disrupt the T-cell receptor alpha constant (TRAC) and CD52 genes. We previously reported the success of this approach in two infants treated under compassionate use who achieved molecular remissions ahead of allogeneic transplantation and remain in remission with follow-up for 18 and 24 months. Here we describe preliminary results of a Phase 1 trial of UCART19 in pediatric patients (pts) with high risk relapsed refractory (R/R) CD19+ B-ALL and no therapeutic options.MethodsThis study evaluates the safety and tolerability of a fixed dose (2x107 total cells or 1.1 to 2.3x106 cells/kg) of UCART19 and its ability to achieve molecular remission at day (D) 28 to enable allogeneic stem cell transplantation (allo-SCT). Up to 10 subjects with R/R B-ALL aged between 6 months and < 18 years, with morphologically confirmed CD19+ B-ALL or an MRD load ≥ 1x10-3 are eligible. The lymphodepletion regimen combines cyclophosphamide and fludarabine with or without alemtuzumab (FC or FCA). UCART19 is administered thereafter (Day 0) as a single dose infusion. If the patient achieves molecular remission, allo-SCT is scheduled within 6 to 12 weeks (wks) after infusion, and trial period continues for a further 12 months before entry into a long-term follow-up study.ResultsAs of 24 June 2017, 5 children (3 males and 2 females), including two infant leukaemias, aged between 8 months and 16.4 years had been enrolled and treated. Four pts had received 3 or more previous lines of treatment and 2 had undergone a previous allo-SCT. All patients were unsuitable for or had failed generation of an autologous CAR T-cell product. All had received debulking chemotherapy and/or inotuzumab ozogamicin therapy before UCART19. All pts received lymphodepletion with FCA. No immediate infusion related reaction (IRR) related to UCART19 were reported. All pts experienced reversible cytokine release syndrome (CRS) (1 grade (G) 1, 3 G2, 1 G3), with one child requiring 2 doses of tocilizumab. Time to onset of first CRS symptoms was between D4 and D8. Two pts presented mild neurological symptoms that recovered (within 1 to 3 days) without treatment. Acute skin GvHD G1 was reported in two pts (one with biopsy confirmation) and both recovered with topical steroids. Four children experienced viral complications (CMV, ADV, BK, metapneumovirus) related to lymphodepletion, and all experienced neutropenia, which was prolonged in 2/5 pts. By D28-42, 5/5 pts had achieved complete remission with incomplete blood count recovery albeit with hypoplastic marrows (all patients were MRD negative by flow cytometry or qPCR ). UCART19 were detectable from D7 to at least D28 in all subjects by qPCR and/or flow cytometry and by molecular signatures of T-cell donor chimerism. All proceeded to conditioned allo-SCT between 7 to 9 weeks after UCART19 infusion, with no gene-modified cells detectable thereafter. Two children relapsed 3 months after transplantation (one CD19- and one CD19+) and died 7 and 8 months after UCART19 infusion respectively. One subject died in remission from transplant related complications including thrombotic microangiopathy and BK haemorrhagic cystitis and nephritis. Two subjects remain in molecular remission 2 and 2.5 months post-transplant.ConclusionPreliminary results of this first-in-human trial of UCART19 treatment in a high risk R/R B-ALL pediatric population revealed no unexpected toxicities. GvHD seen in 2 patients was mild and self-limiting. Lymphodepletion-related viral complications and persisting neutropenia were encountered. All five treated subjects were rendered either flow or PCR MRD negative enabling allogeneic transplantation to proceed. The trial is ongoing in the UK and further data may be presented (NCT02808442) . DisclosuresQasim:Autolus Ltd: Consultancy, Equity Ownership; Miltenyi: Research Funding; Orchard Therapeutics: Consultancy, Equity Ownership; Servier: Research Funding; Bellicum: Research Funding; NIHR: Research Funding; Cellectis: Research Funding. Lucchini:Alexion: Membership on an entity's Board of Directors or advisory committees. Zinaï:Servier: Employment. Binlich:Servier: Employment. Dupouy:Servier: Employment. Pauly:Servier: Employment. Balandraud:Servier: Employment. Dubois:Servier: Employment. Konto:Bristol-Myers Squibb: Employment, Equity Ownership; Pfizer: Employment, Equity Ownership. Patel:Pfizer: Employment, Equity Ownership. Veys:Bellicum: Research Funding; Servier: Research Funding.

A phase 1 dose escalation and cohort expansion study of the safety and efficacy of allogeneic CRISPR-Cas9–engineered T cells (CTX110) in patients (Pts) with relapsed or refractory (R/R) B-cell malignancies (CARBON).

TPS7570 Background: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma (NHL), and although &gt; 50% of pts achieve long-term remission with first-line therapy, pts with R/R disease as well as those with R/R grade 3b follicular lymphoma (FL), double-, or triple-hit high-grade lymphomas have poor long-term outcomes (Crump 2017; Kahl 2016; Jain 2012). Autologous (auto) chimeric antigen receptor (CAR) T cell therapy has provided additional options for pts with R/R disease, but only when leukapheresis and manufacturing prove feasible (Jacobson 2020). Allogeneic (allo) CAR-T cells were designed specifically to address these unmet needs by using healthy donor T cells to produce a readily available product and remove the need for bridging chemotherapy. We are currently investigating the safety and efficacy of CTX110, an allo anti-CD19 CAR-T cell product modified by using CRISPR/Cas9-editing to disrupt the endogenous T-cell receptor (TCR) alpha constant (TRAC) locus in order to remove TCR expression and disrupt β2-microglobulin, which eliminates major histocompatibility complex (MHC) class I expression. Disruption of the TCR should significantly reduce or eliminate risks of graft-versus-host disease and elimination of MHC class I expression may increase CAR-T cell persistence by mitigating CTX110 rejection. In addition, the anti-CD19 CAR transgene construct is precisely inserted into the TRAC locus. Methods: The Phase 1 CARBON trial (NCT04035434) is an open-label, multicenter, global study evaluating the safety and efficacy of CTX110 in pts ≥18 y with R/R DLBCL NOS, double- or triple-hit DLBCL, or transformed or grade 3b FL with ≥2 prior lines of therapy or who are ineligible for/refused prior auto hematopoietic stem cell transplant (HSCT). Pts who received prior auto CAR-T or allo HSCT are excluded. Pts will receive lymphodepleting chemotherapy with fludarabine 30mg/m2 and cyclophosphamide 500mg/m2 for 3 days, followed by CTX110 infusion. In part A, dose escalation will be performed using a 3+3 design. Upon completion of dose finding, the cohort will be expanded to further assess safety signals and efficacy including the primary efficacy endpoint of overall response rate. Key secondary efficacy endpoints include duration of response, progression-free survival, and overall survival. The trial is currently open and enrolling. Clinical trial information: NCT04035434.