Uckun Fatih M, Watts Justin, Mims Alice S, Patel Prapti, Wang Eunice, Shami Paul J, Cull Elizabeth, Lee Cynthia, Cogle Christopher R, Lin Tara L
Department of Regulatory Affairs and Clinical Research, Aptevo Therapeutics, Seattle, WA 98121, USA.
Immuno-Oncology Program, Ares Pharmaceuticals, St. Paul, MN 55110, USA.
Cancers (Basel). 2021 Oct 21;13(21):5287. doi: 10.3390/cancers13215287.
We evaluate the risk, characteristics and biomarkers of treatment-emergent cytokine release syndrome (CRS) in patients with relapsed/refractory acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) who received APVO436 during the dose-escalation phase of a Phase 1B study (ClinicalTrials.gov, identifier: NCT03647800). Of four patients who developed Grade ≥ 3 CRS, two received steroid prophylaxis. The dose level, gender, race, obesity, or baseline hematologic parameters in peripheral blood did not predict the risk of CRS. Patients with a higher leukemia burden as determined by a higher total WBC, higher percentage of blasts in bone marrow, or higher percentage of blasts in peripheral blood (by hematopathology or immunophenotyping) did not have a higher incidence of CRS. There was an age difference between patients who did versus patients who did not develop CRS (72.9 ± 1.6 years (Median 73.5 years) vs. 63.3 ± 2.3 years (Median: 65.0 years), which was borderline significant ( = 0.04). Premedication with steroids did not eliminate the risk of CRS. Cytokine profiling in patients who developed CRS after APVO436 infusion indicates that the predominant cytokine in this inflammatory cytokine response was IL-6. APVO436-associated CRS was generally manageable with tocilizumab with or without dexamethasone. Notably, the development of CRS after APVO436 therapy did not appear to be associated with a response. The prolonged stabilization of disease, partial remissions and complete remissions were achieved in both patients who experienced CRS, as well as patients who did not experience CRS after APVO436 infusions.
我们评估了在1B期研究剂量爬坡阶段接受APVO436治疗的复发/难治性急性髓系白血病(AML)或骨髓增生异常综合征(MDS)患者中,治疗引发的细胞因子释放综合征(CRS)的风险、特征和生物标志物(ClinicalTrials.gov标识符:NCT03647800)。在出现≥3级CRS的4例患者中,2例接受了类固醇预防。外周血中的剂量水平、性别、种族、肥胖情况或基线血液学参数均不能预测CRS风险。通过较高的白细胞总数、骨髓中较高的原始细胞百分比或外周血中较高的原始细胞百分比(通过血液病理学或免疫表型分析)确定白血病负荷较高的患者,CRS发生率并未更高。发生CRS的患者与未发生CRS的患者之间存在年龄差异(72.9±1.6岁(中位数73.5岁)对63.3±2.3岁(中位数:65.0岁)),差异接近显著(P = 0.04)。使用类固醇进行预处理并不能消除CRS风险。APVO436输注后发生CRS的患者的细胞因子谱分析表明,这种炎性细胞因子反应中的主要细胞因子是IL-6。APVO436相关的CRS通常使用托珠单抗联合或不联合地塞米松均可控制。值得注意的是,APVO436治疗后CRS的发生似乎与疗效无关。在APVO436输注后发生CRS的患者以及未发生CRS的患者中均实现了疾病的长期稳定、部分缓解和完全缓解。
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