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Swan D, Henderson R, McEllistrim C, Naicker SD, Quinn J, Cahill MR, Mykytiv V, Lenihan E, Mulvaney E, Nolan M, Parker I, Natoni A, Lynch K, Ryan AE, Szegezdi E, Krawczyk J, Murphy P, O'Dwyer M. CyBorD-DARA in Newly Diagnosed Transplant-Eligible Multiple Myeloma: Results from the 16-BCNI-001/CTRIAL-IE 16-02 Study Show High Rates of MRD Negativity at End of Treatment. Clin Lymphoma Myeloma Leuk 2022; 22:847-852. [PMID: 35985959 DOI: 10.1016/j.clml.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
The phase 1b 16-BCNI-001/CTRIAL-IE 16-02 CyBorD-DARA trial investigated the combination of Daratumumab with cyclophosphamide, bortezomib and dexamethasone in patients with newly diagnosed multiple myeloma (NDMM), followed by autologous stem cell transplantation and Daratumumab maintenance. CR/sCR rates were 50% after transplant and 62.5% at end of treatment. The overall percentage of patients achieving complete response or better was 77.8%. Progression-free survival rate at end of maintenance was 81.3% and estimated 2-year overall survival was 88.9%. 37.5% of patients demonstrated sustained MRD negativity to a level of 10-5 from transplant to analysis at EOT. In this phase 1b study, we have shown CyBorD-DARA to be an effective and well-tolerated immunomodulatory agent-free regiment in transplant-eligible NDMM.
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Affiliation(s)
- D Swan
- Department of Hematology, University Hospital Galway, Galway, Ireland.
| | - R Henderson
- Department of Hematology, University Hospital Galway, Galway, Ireland
| | - C McEllistrim
- Department of Hematology, University Hospital Galway, Galway, Ireland
| | - S D Naicker
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland; Discipline of Pharmacology & Therapeutics, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J Quinn
- Blood Cancer Network Ireland, Ireland; Department of Haematology, Beaumont Hospital, Dublin, Ireland
| | - M R Cahill
- Blood Cancer Network Ireland, Ireland; Cancer Research at UCC, University College Cork, Cork, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - V Mykytiv
- Department of Hematology, Cork University Hospital, Cork, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - E Lenihan
- Department of Hematology, Cork University Hospital, Cork, Ireland
| | | | - M Nolan
- Cancer Trials Ireland, Dublin, Ireland
| | - I Parker
- Cancer Trials Ireland, Dublin, Ireland
| | - A Natoni
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland; Haematology, Department of Translational and Precision Medicine, Sapienza University
| | - K Lynch
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland; Discipline of Pharmacology & Therapeutics, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A E Ryan
- Discipline of Pharmacology & Therapeutics, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland; Lambe Institute for Translation research, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | | | - J Krawczyk
- Department of Hematology, University Hospital Galway, Galway, Ireland; Blood Cancer Network Ireland, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - P Murphy
- Blood Cancer Network Ireland, Ireland; Department of Haematology, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland
| | - M O'Dwyer
- Department of Hematology, University Hospital Galway, Galway, Ireland; Blood Cancer Network Ireland, Ireland
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Naicker SD, Feerick CL, Lynch K, Swan D, McEllistrim C, Henderson R, Leonard NA, Treacy O, Natoni A, Rigalou A, Cabral J, Chiu C, Sasser K, Ritter T, O'Dwyer M, Ryan AE. Cyclophosphamide alters the tumor cell secretome to potentiate the anti-myeloma activity of daratumumab through augmentation of macrophage-mediated antibody dependent cellular phagocytosis. Oncoimmunology 2021; 10:1859263. [PMID: 33552684 PMCID: PMC7849715 DOI: 10.1080/2162402x.2020.1859263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple Myeloma (MM) is a malignant disorder of plasma cells which, despite significant advances in treatment, remains incurable. Daratumumab, the first CD38 directed monoclonal antibody, has shown promising activity alone and in combination with other agents for MM treatment. Daratumumab is thought to have pleiotropic mechanisms of activity including natural killer (NK) cell-mediated antibody-dependent cellular cytotoxicity (ADCC). With the knowledge that CD38-expressing NK cells are depleted by daratumumab, we sought to investigate a potential mechanism of enhancing macrophage-mediated antibody-dependent cellular phagocytosis (ADCP) by combining daratumumab with cyclophosphamide (CTX). Cyclophosphamide’s immunomodulatory function was investigated by conditioning macrophages with tumor cell secretome collected from cyclophosphamide treated MM cell lines (CTX-TCS). Flow cytometry analysis revealed that CTX-TCS conditioning augmented the migratory capacity of macrophages and increased CD32 and CD64 Fcγ receptor expression on their cell surface. Daratumumab-specific tumor clearance was increased by conditioning macrophages with CTX-TCS in a dose-dependent manner. This effect was impeded by pre-incubating macrophages with Cytochalasin D (CytoD), an inhibitor of actin polymerization, indicating macrophage-mediated ADCP as the mechanism of clearance. CD64 expression on macrophages directly correlated with MM cell clearance and was essential to the observed synergy between cyclophosphamide and daratumumab, as tumor clearance was attenuated in the presence of a FcγRI/CD64 blocking agent. Cyclophosphamide independently enhances daratumumab-mediated killing of MM cells by altering the tumor microenvironment to promote macrophage recruitment, polarization to a pro-inflammatory phenotype, and directing ADCP. These findings support the addition of cyclophosphamide to existing or novel monoclonal antibody-containing MM regimens.
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Affiliation(s)
- Serika D Naicker
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Claire L Feerick
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Kevin Lynch
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Dawn Swan
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Department of Hematology, Galway University Hospital, Galway, Ireland.,Blood Cancer Network Ireland, Galway, Ireland
| | - Cian McEllistrim
- Department of Hematology, Galway University Hospital, Galway, Ireland
| | - Robert Henderson
- Department of Hematology, Galway University Hospital, Galway, Ireland
| | - Niamh A Leonard
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Oliver Treacy
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Alessandro Natoni
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Athina Rigalou
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | - Joana Cabral
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
| | | | - Kate Sasser
- Janssen Research and Development, Pennsylvania, USA
| | - Thomas Ritter
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,CÚRAM, SFI Research Centre for Medical Devices, NUI Galway, Galway, Ireland
| | - Michael O'Dwyer
- School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Department of Hematology, Galway University Hospital, Galway, Ireland.,Blood Cancer Network Ireland, Galway, Ireland.,CÚRAM, SFI Research Centre for Medical Devices, NUI Galway, Galway, Ireland
| | - Aideen E Ryan
- Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Discipline of Pharmacology and Therapeutics, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland.,Blood Cancer Network Ireland, Galway, Ireland.,CÚRAM, SFI Research Centre for Medical Devices, NUI Galway, Galway, Ireland
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