A Phase 1 Trial of CNDO-109–Activated Natural Killer Cells in Patients with High-Risk Acute Myeloid Leukemia

Todd A. Fehniger, Jeffrey S. Miller, Robert K. Stuart, Sarah Cooley, Amandeep Salhotra, Julie Curtsinger, Peter Westervelt, John F. DiPersio, Timothy M. Hillman, Nova Silver, Michael Szarek, Leonid Gorelik, Mark W. Lowdell, Eric Rowinsky

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14 Scopus citations

Abstract

Natural killer (NK) cells are an emerging immunotherapy approach to acute myeloid leukemia (AML); however, the optimal approach to activate NK cells before adoptive transfer remains unclear. Human NK cells that are primed with the CTV-1 leukemia cell line lysate CNDO-109 exhibit enhanced cytotoxicity against NK cell–resistant cell lines. To translate this finding to the clinic, CNDO-109–activated NK cells (CNDO-109-NK cells) isolated from related HLA-haploidentical donors were evaluated in a phase 1 dose-escalation trial at doses of 3 × 105 (n = 3), 1 × 106 (n = 3), and 3 × 106 (n = 6) cells/kg in patients with AML in first complete remission (CR1) at high risk for recurrence. Before CNDO-109-NK cell administration, patients were treated with lymphodepleting fludarabine/cyclophosphamide. CNDO-109-NK cells were well tolerated, and no dose-limiting toxicities were observed at the highest tested dose. The median relapse-free survival (RFS) by dose level was 105 (3 × 105), 156 (1 × 106), and 337 (3 × 106) days. Two patients remained relapse-free in post-trial follow-up, with RFS durations exceeding 42.5 months. Donor NK cell microchimerism was detected on day 7 in 10 of 12 patients, with 3 patients having evidence of donor cells on day 14 or later. This trial establishes that CNDO-109-NK cells generated from related HLA haploidentical donors, cryopreserved, and then safely administered to AML patients with transient persistence without exogenous cytokine support. Three durable complete remissions of 32.6 to 47.6+ months were observed, suggesting additional clinical investigation of CNDO-109-NK cells for patients with myeloid malignancies, alone or in combination with additional immunotherapy strategies, is warranted.

Original languageEnglish (US)
Pages (from-to)1581-1589
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number8
DOIs
StatePublished - Aug 2018

Keywords

  • Acute myeloid leukemia
  • CNDO-109–activated natural killer cells

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    Fehniger, T. A., Miller, J. S., Stuart, R. K., Cooley, S., Salhotra, A., Curtsinger, J., Westervelt, P., DiPersio, J. F., Hillman, T. M., Silver, N., Szarek, M., Gorelik, L., Lowdell, M. W., & Rowinsky, E. (2018). A Phase 1 Trial of CNDO-109–Activated Natural Killer Cells in Patients with High-Risk Acute Myeloid Leukemia. Biology of Blood and Marrow Transplantation, 24(8), 1581-1589. https://doi.org/10.1016/j.bbmt.2018.03.019