New Agents in DLBCL Targeting Macrophages Stephen M. Ansell, MD, - PowerPoint PPT Presentation

New Agents in DLBCL – Targeting Macrophages Stephen M. Ansell, MD, PhD Professor of Medicine Chair, Lymphoma Group Mayo Clinic

Peripheral blood monocyte numbers are associated with prognosis A. B. <570 <630 ≥570 ≥630 No. at risk No. at risk AMC low AMC low AMC high AMC high Follicular lymphoma DLBCL Wilcox et al. Leukemia. 2011 Sep;25(9):1502-9. Wilcox et al. Leuk Lymphoma. 2012 Apr;53(4):575-80.

CD14+HLA-DR low monocytes are associated with immunosuppression A. B. HLA-DR low (cells/ μl ) CD14 NHL Ctrl HLADR C. D. HLA-DR expression Alone Untreated Mo IL-10 treated Mo (MFI) CFSE Xiu et al. Blood Cancer J. 2015 Jul 31;5:e328.

Intratumoral monocytes have a different phenotype B. A. CD68 stain, 400X CD14 stain, 400X D. C. CD163 stain, 400X Merged image

A. Normal Large cell lymphoma Follicular lymphoma F E E B C G D H C1 A Density B. A B C E D G H F CD14 SIRP α CD16 CD36 CD38 CD163 HLA-DR CD33 CD11c CD11b CD32

A. B. CD14 Lin CD68 C. D. CD163 SIRP α CD14 CD14

Mechanism of Phagocytosis calreticulin

A Phase 1 Study of TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies Ansell SM et al, ASH 2016, #1812

A Phase 1 Study of TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies Ansell SM et al, ASH 2016, #1812

A Phase 1 Study of TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies Ansell SM et al, ASH 2016, #1812

A Phase 1 Study of TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies Ansell SM et al, ASH 2016, #1812

A Phase 1 Study of TTI-621 in Patients with Relapsed or Refractory Hematologic Malignancies Nov 2016 Dec 2016 Jan 2017 SIRPa-Fc + Rituximab Initial Dx – transformed lymphoma Ansell SM et al, ASH 2016, #1812

First-in-human, first-in-class phase I trial of the anti-CD47 antibody Hu5F9-G4 in patients with advanced cancers • Adults with solid tumors - Part A to determine the optimal Priming Dose, Part B to determine the optimal Maintenance Dose. • 16 patients have been enrolled, 11 in Part A and 5 in Part B. • In Part A, 1 mg/kg dose was selected as the Priming Dose. • In Part B, the study is ongoing with the current cohort at 1 mg/kg followed by 10 mg/kg weekly. • Hu5F9-G4-related AEs - anemia (11 G1, 5 G2), hyperbilirubinemia (5 G1, 3 G2, 1 G3), headache (9 G1, 1 G2), nausea (3 G1), and retinal toxicity (1 G2). • Most AEs were associated with the Priming Dose and were reversible. • Two patients (adenoid cystic ca) had stable disease for 16 and 8 months. Sikic et al. J Clin Oncol 34, 2016 (suppl; abstr 3019)

Targeting CD47/SIRPα in Lymphoma

Acknowledgements Lab members - Zhi-Zhang Yang Hyo Jin Kim Ya-Ping Chen Tammy Price Troska JC Villasboas Anne Novak Grant funding – National Institutes of Health, Leukemia & Lymphoma Society, Lymphoma Research Foundation, Predolin Foundation.