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  • First-in-human phase 1 clin...
    Romee, Rizwan; Cooley, Sarah; Berrien-Elliott, Melissa M.; Westervelt, Peter; Verneris, Michael R.; Wagner, John E.; Weisdorf, Daniel J.; Blazar, Bruce R.; Ustun, Celalettin; DeFor, Todd E.; Vivek, Sithara; Peck, Lindsey; DiPersio, John F.; Cashen, Amanda F.; Kyllo, Rachel; Musiek, Amy; Schaffer, András; Anadkat, Milan J.; Rosman, Ilana; Miller, Daniel; Egan, Jack O.; Jeng, Emily K.; Rock, Amy; Wong, Hing C.; Fehniger, Todd A.; Miller, Jeffrey S.

    Blood, 06/2018, Letnik: 131, Številka: 23
    Journal Article

    New therapies for patients with hematologic malignancies who relapse after allogeneic hematopoietic cell transplantation (allo-HCT) are needed. Interleukin 15 (IL-15) is a cytokine that stimulates CD8+ T-cell and natural killer (NK) cell antitumor responses, and we hypothesized this cytokine may augment antileukemia/antilymphoma immunity in vivo. To test this, we performed a first-in-human multicenter phase 1 trial of the IL-15 superagonist complex ALT-803 in patients who relapsed >60 days after allo-HCT. ALT-803 was administered to 33 patients via the IV or subcutaneous (SQ) routes once weekly for 4 doses (dose levels of 1, 3, 6, and 10 μg/kg). ALT-803 was well tolerated, and no dose-limiting toxicities or treatment-emergent graft-versus-host disease requiring systemic therapy was observed in this clinical setting. Adverse events following IV administration included constitutional symptoms temporally related to increased serum IL-6 and interferon-γ. To mitigate these effects, the SQ route was tested. SQ delivery resulted in self-limited injection site rashes infiltrated with lymphocytes without acute constitutional symptoms. Pharmacokinetic analysis revealed prolonged (>96 hour) serum concentrations following SQ, but not IV, injection. ALT-803 stimulated the activation, proliferation, and expansion of NK cells and CD8+ T cells without increasing regulatory T cells. Responses were observed in 19% of evaluable patients, including 1 complete remission lasting 7 months. Thus, ALT-803 is a safe, well-tolerated agent that significantly increased NK and CD8+ T cell numbers and function. This immunostimulatory IL-15 superagonist warrants further investigation to augment antitumor immunity alone and combined with other immunotherapies. This trial was registered at www.clinicaltrials.gov as #NCT01885897. •Single-agent IL-15/IL-15Rα-Fc (ALT-803) therapy was well tolerated and resulted in clinical responses in patients who relapsed post-HCT.•First-in-human use of ALT-803 promoted NK and CD8+ T-cell expansion and activation in vivo without stimulating regulatory T cells. Display omitted