Abstract CT143: IFN-γ and donor leukocyte infusion to treat relapsed myeloblastic malignancies after allogeneic hematopoietic stem cell transplantation
Authors: Ito Sawa , Geramita Emily , Ventura Kedwin , Neupane Biswas , Bhise Shruti , Furlan Scott N. , Shromchik Warren D. 
Published: April 2024

Abstract
Introduction: Allogeneic stem cell transplantation (alloSCT) can provide a cure for myeloid malignancies partially through the graft-vs-leukemia effect (GVL), wherein donor-derived alloreactive T cells attack recipient leukemia cells. Preclinical data strongly suggested IFN-γ is crucial for effective GVL against myeloblastic leukemia. IFN-γ receptor gene-deficient myeloblastic leukemia were resistant to GVL in mouse models (Matte-Martone, Shlomchik JCI 2017). IFN-γ upregulated HLA expression in relapsed myeloblasts in vitro (Christopher NEJM 2018, Toffalori Nat Med 2019). We hypothesized that IFN-γ would sensitize myeloblasts to alloreactive T cells and promote GVL. Here, we present the results of a phase 1 study to evaluate the safety of IFN-γ combined with donor leukocyte infusions (DLI) for relapsed myeloblastic malignancies post-transplant (NCT04628338).
Methods: HLA-matched donor alloSCT recipients with relapsed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and no active graft-versus-host disease (GVHD) were eligible. Patients self-administered 100mcg IFN-γ (Actimmune, Horizon Therapeutics) three times a week for 4 weeks (cohort 1) or 1 week (cohort 2), followed by DLI and concurrent IFN-γ for a total of 12 weeks. Flow cytometry-based surface HLA expression and single-cell RNAseq (scRNAseq) were analyzed using bone marrow (BM) collected before and after IFN-γ.
Results: Seven patients with high-risk diseases (2 MDS and 5 AML) were enrolled. There were no serious adverse events during IFN-γ monotherapy. After DLI, 5 patients developed grade I-II GVHD along with immune effector cell-associated neurotoxicity syndrome (grade 1 or 2; n=2) and idiopathic pneumonia syndrome (IPS; n=1). All immune-mediated toxicities, including IPS, resolved with corticosteroids. 4 out of 6 DLI recipients achieved minimal residual disease negative complete remissions and full donor hematopoietic cell reconstitution. The median overall survival was 579 days (range, 97-906) in responders. Myeloid blasts upregulated HLA-DR after IFN-γ, and enrichment of recipient malignant hematopoietic stem cells expressing CIITA was observed in post-IFN-γ BM by scRNAseq.
Conclusions: This first in human use of IFN-γ to treat post-transplant relapse was safe, with a promising efficacy signal when combined with DLI. Correlative studies support our hypothesis that in vivo IFN-γ activates myeloblasts, manifest by HLA-DR upregulation and CIITA induction. We plan to design a phase 2 trial to formally test the efficacy of this novel immunotherapeutic approach to boost GVL in alloSCT.
Citation Format: Sawa Ito, Emily Geramita, Kedwin Ventura, Biswas Neupane, Shruti Bhise, Scott N. Furlan, Warren D. Shromchik. IFN-γ and donor leukocyte infusion to treat relapsed myeloblastic malignancies after allogeneic hematopoietic stem cell transplantation  [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT143.