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. WU-CART-007 is a CD7-targeted CAR-T cell product with CRISPR/Cas9 deletion of CD7 and T-cell receptor alpha constant (TRAC), to prevent fratricide and enable the use of 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 R/R T-ALL/LBL in an ongoing global first-in-human, Phase 1/2 single-agent study (NCT04984356).The RP2D of WU-CART-007 is 900 million (M) cells administered on day 1 following lymphodepleting chemotherapy (LDC). Disease response is assessed by Day 28 bone marrow (BM) aspirate/biopsy, and/or CT/PET.As of July 21, 2023, 18 pts have been dosed with WU-CART-007 (n = 11 T-ALL, n = 7 T-LBL); 3 in DL1 with (100M), 3 in DL2 (300M), 6 in DL3 (600M), and 6 in DL4 (900M). 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) relapsed following an allogeneic HSCT. Disease burden at baseline consisted of extramedullary disease (EMD) in 28% (5) of pts, and a median BM blast count of 60% (range 5-98%) in pts with BM disease (13). 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 (78%) pts. Most (72%; 13) pts had G1-2 CRS events; a single G3 CRS event was reported which resolved within 72 hours after receiving tocilizumab, steroids, 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 due to fungal infection and not attributed to WU-CART-007.WU-CART-007 showed dose-dependent anti-tumor activity. In evaluable patients at DL≥ 2 (n=12) Composite Complete Remission Rate (CRc; CR + CRi + CRh): 58% (86% MRDneg), 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 52,150 copies/ug DNA) and persisted out to day 56. Of all pts tested (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 expression of activation markers (KI67, CD38, HLA-DR) and 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.