PURPOSE Axicabtagene ciloleucel (axi-cel) was approved by the Food and Drug Administration for relapsed aggressive B-cell non-Hodgkin lymphoma in part on the basis of durable remission rates of approximately 40% in a clinical trial population. Whether this efficacy, and the rates of toxicity, would be consistent in a postcommercial setting, with relaxed eligibility criteria and bridging therapy, is unknown. This study describes the efficacy and safety correlates and outcomes in this setting. PATIENTS AND METHODS One hundred twenty-two patients from 7 medical centers in the United States were treated with axi-cel and were included in a modified intent-to-treat (mITT) analysis. Seventy-six patients (62%) were ineligible for the ZUMA-1 trial. Response and toxicity rates, duration of response (DOR), survival, and covariates are described on the basis of the mITT population. Correlative studies on blood and tumor samples were performed to investigate potential biomarkers of response and resistance. RESULTS Median follow-up was 10.4 months. In the mITT population, the best overall and complete response (CR) rates were 70% and 50%, respectively. Median DOR and progression-free survival (PFS) were 11.0 and 4.5 months in all patients and were not reached (NR) in CR patients. Median overall survival (OS) was NR; 1-year OS was 67% (95% CI, 59% to 77%). Although response rates were similar in the ZUMA-1–eligible and ZUMA-1–ineligible groups (70% v 68%), there was a statistically significant improvement in CR rate (63% v 42%, P = .016), DOR (median, NR v 5.0 months; P = .014), PFS (median, NR v 3.3 months; P = .020), and OS (1-year OS, 89% v 54%; P < .001) in patients who were ZUMA-1 eligible. Rates of grade ≥ 3 cytokine release syndrome and neurotoxicty were 16% and 35%, respectively. CONCLUSION Axi-cel yields similar rates of overall response and toxicity in commercial and trial settings, although CR rates and DOR were more favorable in patients eligible for ZUMA-1.

eThe total cellular lipids of Porphyromas gingivalis, a known periodontal pathogen, were previously shown to promote dendritic cell activation and inhibition of osteoblasts through engagement of Toll-like receptor 2 (TLR2). The purpose of the present investigation was to fractionate all lipids of P. gingivalis and define which lipid classes account for the TLR2 engagement, based on both in vitro human cell assays and in vivo studies in mice. Specific serine-containing lipids of P. gingivalis, called lipid 654 and lipid 430, were identified in specific high-performance liquid chromatography fractions as the TLR2-activating lipids. The structures of these lipids were defined using tandem mass spectrometry and nuclear magnetic resonance methods. T oll-like receptors (TLRs) represent a diverse family of molecules that play a critical role in activating the innate immune system in response to pathogens (1, 2). Toll-like receptor 2 (TLR2) recognizes diverse molecular structures of microbial cell wall origin, including lipoteichoic acid, lipoproteins, peptidoglycan from Gram-positive bacteria, lipoarabinomannan from mycobacteria, and zymosan from yeast cell walls. TLR2 is reported to be activated by many other microbial products, including phenol-soluble modulins (3) and Porphyromonas gingivalis lipoprotein (4), lipopolysaccharide (LPS) (5-7), and fimbriae (8-10). However, two recent reports have questioned the extent to which lipoprotein, LPS, or fimbriae mediate TLR2 engagement by P. gingivalis (11,12).We previously reported that the total lipid extract of P. gingivalis promotes activation of mouse dendritic cells and inhibits osteoblast-mediated bone deposition through engagement of TLR2 (13,14). These effects were attributed to the dominant phosphorylated dihydroceramide lipids of P. gingivalis, in particular, phosphoethanolamine dihydroceramides. These studies reported engagement of TLR2 only in vitro in mouse cells. Recent reports have demonstrated TLR2-dependent periodontal bone loss in mice following oral infection with P. gingivalis (15,16). Most recently, cell adhesion mediated through the expression of fimbriae by P. gingivalis has been implicated in promoting of TLR2-dependent oral bone loss (17). In contrast, two recent reports indicated that the capacity of fimbriae to engage TLR2 is dependent on the presence of a contaminating factor that is susceptible to hydrolysis by lipoprotein lipase (11,18).In addition to effects on mouse cells, the phosphorylated dihydroceramide lipids of P. gingivalis have been shown to promote proinflammatory responses in human fibroblasts and to cause disruption of human fibroblast adherence/vitality in culture (19). However, it is not clear whether these effects require engagement of TLR2. Since the total lipid extract of P. gingivalis has been shown to activate TLR2 in mice and in mouse cells, the primary purpose of this investigation was to further identify and characterize the specific lipid classes of P. gingivalis that are responsible for engagement of TLR2 and, specifica...

Introduction: CD19 CAR T cells lead to durable responses in 40% of r/r aggressive B cell NHL patients. We performed a multicenter retrospective study of axicabtagene ciloleucel given in a real world setting where eligibility/management considerations may diverge from clinical trials. We evaluate efficacy and safety, and patient/disease factors associated with response and toxicity. Methods: Patient and treatment characteristics were summarized descriptively. Response and toxicity were reported with 95% exact binomial CIs. CyTOF was performed on frozen PBMCs using 38 metal-tagged mAbs. Multiplex IF was performed on FFPE tissue with standard, primary Abs sequentially, paired with a unique fluorochrome per published protocols. Standard IHC was done on FFPE whole tissue. Results: In total, 76 patients, median age 64, were included (Table 1). The majority had an ECOG PS ≤ 2. Twenty-one percent of patients had double/triple hit cytogenetics. Nearly half had an IPI ≥3 at treatment. Nearly 1/3 had a prior autologous transplant, 25% had prior ibrutinib, and 11% had prior lenalidomide. Twelve percent had bulky disease and 36% received bridging therapy following pheresis. Seventy-three patients were evaluable for response (Table 2). At 4m median f/u, best ORR and CRR was 64% and 41% among those treated. Six patients had 6m f/u, all PRs at 1m: 3 converted to CR and 3 had PD. Eleven patients (13%) were pheresed but not treated due to PD (6), infection (2), or non-conforming cells (3). By ITT analysis, the ORR and CRR were 57% and 36%. OS at 4m among those treated was 84%; PFS will be calculated with longer f/u. In univariate analysis, PS, tumor bulk, IPI, baseline CRP and prior ibrutinib were significantly associated with lack of response (Table 3). There was no association between response and double/triple hit cytogenetics, grade 3+ CRS or NT, or the use of tocilizumab/steroids. Among treated patients, 96% experienced CRS; in 17% this was ≥ grade 3. Two patients died from CRS (3%). Median time to onset was 1d; median duration was 6d (0-14d). NT was seen in 76% of patients; in 38% this was ≥ grade 3. One case of NT was fatal. Median time to onset was 5d; median duration was 8d (0-34d). Tocilizumab and steroids were given to 67% and 78% of patients. ICU care occurred in 30% of patients. Eleven treated patients have died: 6 from PD and 5 from toxicity. In univariate analysis, peak ferritin was associated with grade 3+ CRS and NT; peak ALC was associated with grade 3+ CRS, and peak CRP and prior autologous transplant were associated with grade 3+ NT (Table 4). Three of 4 patients who had a biopsy with CD19 staining after relapse were positive (Fig 1). All 3 patients with PDL1+ tumors were refractory to CAR T cell therapy. Multiplex IF and IHC were performed on 2 primary refractory patients at progression (Fig 1). One was CD19-/PDL1+; multiplex IF showed an abundance of CAR+ T-cells (Fig 1A,B). The second was CD19+/PDL1- and multiplex IF showed no CAR+ T-cells (Fig 1C,D). CyTOF analysis of PBMCs at serial timepoints was performed on 6 patients (4 CRs, 1 PD, 1 PD after CR)(Fig 2, Table 5). Peak CAR T cell levels were seen at day 7 in all patients with increased expression of PD1, 41BB, and Ki67, as well as CC3 indicating apoptosis, followed by a reduction in CAR T cells by day 14. Immune subsets that associate with response will be evaluated and reported. Results from additional patients and longer f/u will be presented. Conclusion: Retrospective analysis of a multicenter cohort treated in the real world with axi-cel reveals important distinctions from ZUMA-1. The ORR and CR rate are lower than the 82% and 54% reported on ZUMA-1. This may reflect inclusion of sicker patients with a poorer PS, and/or with different histologies (ie transformation from non-FL). Outcomes were significantly worse in high risk lymphomas, reflected by IPI, PS, tumor bulk, and baseline CRP. Rates of CRS and NT were similar to ZUMA-1, but toxicity was not associated with tumor bulk or response. It was associated with higher peak inflammatory markers and ALC, which may reflect peak CAR T cell levels, as shown previously. Progression biopsies highlight 3 potential resistance mechanisms: loss of target antigen, an inhibitory tumor/TME, and lack of CAR T cell tumor infiltration. Immunomodulatory molecules on CAR T cells that may affect their activity and survival are upregulated early. This suggests that unique combination approaches are necessary for specific patients/tumors. Disclosures Jacobson: Precision Bioscience: Consultancy; Kite: Consultancy; Pfizer: Consultancy; Bayer: Consultancy; Humanigen: Consultancy; Novartis: Consultancy. Rodig:Merck: Research Funding; Affimed: Research Funding; Bristol Myers Squibb: Research Funding; KITE: Research Funding. Maus:novartis: Consultancy; agentus: Consultancy, Research Funding; crispr therapeutics: Consultancy, Research Funding; kite therapeutics: Consultancy, Research Funding; windmil therapeutics: Consultancy; adaptimmune: Consultancy. Chen:Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Magenta Therapeutics: Consultancy; REGiMMUNE: Consultancy; Takeda Pharmaceuticals: Consultancy. Abramson:Verastem: Consultancy; Amgen: Consultancy; Merck: Consultancy; Karyopharm: Consultancy; Humanigen: Consultancy; Bayer: Consultancy; Gilead: Consultancy; Celgene: Consultancy; Seattle Genetics: Consultancy; Novartis: Consultancy; Juno Therapeutics: Consultancy. Kline:iTeos: Research Funding; Merck: Honoraria, Research Funding. Cohen:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Infinity Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Infinity Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Research Funding; Bristol-Myers Squibb: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Research Funding; Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Millennium: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees; BioInvent: Consultancy; Seattle Genetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Research Funding; BioInvent: Consultancy. Jaglowski:Novartis Pharmaceuticals Corporation: Consultancy, Research Funding; Kite Pharma: Consultancy, Research Funding; Juno: Consultancy. Smith:Merck Sharp and Dohme Corp.: Consultancy, Research Funding; Acerta Pharma BV: Research Funding; Pharmacyclics: Research Funding; Genentech: Research Funding; Incyte Corporation: Research Funding; Portola Pharmaceuticals: Research Funding; Seattle Genetics: Research Funding. Maloney:Janssen Scientific Affairs: Honoraria; Seattle Genetics: Honoraria; Juno Therapeutics: Research Funding; Roche/Genentech: Honoraria; GlaxoSmithKline: Research Funding. Gopal:Spectrum: Research Funding; Seattle Genetics: Consultancy, Research Funding; Merck: Research Funding; Janssen: Consultancy, Research Funding; Takeda: Research Funding; Gilead: Consultancy, Research Funding; Pfizer: Research Funding; BMS: Research Funding; Brim: Consultancy; Teva: Research Funding; Aptevo: Consultancy; Incyte: Consultancy; Asana: Consultancy. Acharya:Teva: Honoraria; Juno Therapeutics: Research Funding.

Classical Hodgkin lymphoma (cHL) is characterized by nearly universal genetic alterations in 9p24.1, resulting in constitutive expression of PD-1 ligands. This likely underlies the unique sensitivity of cHL to PD-1 blockade, with response rates of ∼70% in relapsed/refractory disease. There are now numerous clinical trials testing PD-1 inhibitors in earlier stages of treatment and in combination with many other therapies. In general, non-Hodgkin lymphomas (NHLs) do not display a high frequency of 9p24.1 alterations and do not share cHL’s vulnerability to PD-1 blockade. However, a few entities have genetic or immunologic features that may predict sensitivity to immune checkpoint blockade. These include primary mediastinal B cell lymphoma, primary central nervous system lymphoma, and primary testicular lymphoma, which harbor frequent alterations in 9p24.1, as well as Epstein Barr virus (EBV)–infected lymphomas, where EBV infection leads to increased PD-L1 expression. Although these subtypes may be specifically vulnerable to PD-1 blockade, the majority of NHLs appear to be minimally sensitive to PD-1 blockade monotherapy. Current investigations in NHL are therefore focusing on targeting other checkpoints or studying PD-1–based combination therapy. Looking forward, additional insight into the most common mechanisms of resistance to immune checkpoint inhibitors will be important to guide rational clinical trial design. In this review, we describe the biological basis for checkpoint blockade in cHL and NHL and summarize the clinical data generated to date. Guided by our rapidly evolving understanding of the pathobiology of various lymphoma subtypes, we are hopeful that the role of checkpoint inhibitors in lymphoma treatment will continue to grow.

Therapeutics, and Amgen; and other fees from Pieris Pharmaceutical, Boston Pharmaceuticals, and Zumutor. In addition, FSH has a patent for treating MICA-related disorders (20100111973) with royalties paid, a patent for tumor antigens and uses thereof (7250291), a pending patent for angiopoietin-2 biomarkers predictive of anti-immune checkpoint response (20170248603), a pending patent for compositions and methods for identification, assessment, prevention, and treatment of melanoma using PD-L1 Isoforms (20160340407), a pending patent for therapeutic peptides (20160046716), a pending patent for therapeutic peptides (20140004112), a pending patent for therapeutic peptides (20170022275), a pending patent for therapeutic peptides (20170008962), a pending patent for methods of using pembrolizumab and trebananib, a patent for vaccine compositions and methods for restoring NKG2D pathway function against cancers (10279021), and a patent for antibodies that bind to MHC class I polypeptide-related sequence A (2008036981A9). ZJR, SAS, JR, AB, WG are employees of Kite, a Gilead company.