Daratumumab in Pediatric Relapsed/Refractory Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma: DELPHINUS Study.
Teena BhatlaLaura HoganDavid Trent TeacheyFrancisco J Bautista SirventJohn P MoppettPablo Velasco PuyóConcetta MicalizziClaudia RossigNeerav Narendra ShuklaGil GiladFranco LocatelliAndre BaruchelMichel ZwaanNatalie S BezlerAlba Rubio-San-SimónDavid TaussigElizabeth A RaetzZhengwei J MaoBrent WoodDiana Alvarez AriasMaria KrevvataIvo NnaneNibedita BandyopadhyayLorena Lopez SolanoRobyn M DennisRobin CarsonAjay VoraPublished in: Blood (2024)
Patients with relapsed/refractory acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) have poor outcomes compared with newly diagnosed, treatment-naïve patients. The phase 2, open-label DELPHINUS study evaluated daratumumab (16 mg/kg intravenously) plus backbone chemotherapy in children with relapsed/refractory B-cell ALL (n=7) after ≥2 relapses and children and young adults with T-cell ALL (children, n=24; young adults, n=5) or LL (n=10) after first relapse. The primary endpoint was complete response (CR) in the B-cell ALL (end of Cycle 2) and T-cell ALL (end of Cycle 1) cohorts, after which patients could proceed off study to allogeneic hematopoietic stem cell transplant (HSCT). Seven patients with advanced B-cell ALL received daratumumab with no CRs achieved; this cohort was closed due to futility. For the childhood T-cell ALL, young adult T-cell ALL, and T-cell LL cohorts, the CR (end of Cycle 1) rates were 41.7%, 60.0%, and 30.0%, respectively; overall response rates (any time point) were 83.3% (CR+CR with incomplete count recovery [CRi]), 80.0% (CR+CRi), and 50.0% (CR+partial response); minimal residual disease-negativity (<0.01%) rates were 45.8%, 20.0%, and 50.0%; observed 24-month event-free survival rates were 36.1%, 20.0%, and 20.0%; observed 24-month overall survival rates were 41.3%, 25.0%, and 20.0%; and allogeneic HSCT rates were 75.0%, 60.0%, and 30.0%. No new safety concerns with daratumumab were observed. In conclusion, daratumumab was safely combined with backbone chemotherapy in children and young adults with T-cell ALL/LL and contributed to successful bridging to HSCT. This trial was registered at www.ClinicalTrials.gov as NCT03384654.
Keyphrases
- young adults
- acute lymphoblastic leukemia
- multiple myeloma
- hematopoietic stem cell
- newly diagnosed
- end stage renal disease
- free survival
- diffuse large b cell lymphoma
- acute myeloid leukemia
- stem cell transplantation
- open label
- ejection fraction
- clinical trial
- childhood cancer
- chronic kidney disease
- peritoneal dialysis
- allogeneic hematopoietic stem cell transplantation
- type diabetes
- patient reported outcomes
- study protocol
- peripheral blood
- adipose tissue
- squamous cell carcinoma
- locally advanced
- high dose
- weight loss
- insulin resistance
- replacement therapy