TTI-622 in Combination With Pembrolizumab for the Treatment of Relapsed or Refractory Diffuse Large B-Cell Lymphoma

Exclusion Criteria

• •Primary central nervous system (CNS) lymphoma or known CNS involvement by lymphoma at screening as confirmed by magnetic resonance imaging (MRI)/computed tomography (CT) scan (brain) and, if clinically indicated, by lumbar puncture
• •Known past or current malignancy other than inclusion diagnosis, except for:
• •* Cervical carcinoma of Stage 1B or less
• •* Non-invasive basal cell or squamous cell skin carcinoma
• •* Non-invasive, superficial bladder cancer
• •* Prostate cancer with a current prostate specific antigen (PSA) level \< 0.1 ng/mL
• •* Any curable cancer with a complete response (CR) of \> 2 years duration
• •Received \< 2 prior systemic anti-cancer therapy including investigational agents =\< 4 weeks or =\< 5 half-lives, whichever is shorter, prior to registration
• •Received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (e.g., CTLA-4, OX-40, CD137) =\< 4 weeks prior to registration
• •Known clinically significant cardiac disease, including:
• •* Onset of unstable angina pectoris within 6 months of signing informed consent form (ICF)
• •* Acute myocardial infarction within 6 months of signing ICF
• •* Congestive heart failure (grade III or IV as classified by the New York Heart Association and/or known decrease ejection fraction of \< 45%)
• •Chronic ongoing infectious diseases (except hepatitis B or hepatitis C) requiring treatment (excluding prophylactic treatment) at the time of enrollment or =\< the previous 2 weeks
• •Confirmed history or current autoimmune disease or other diseases resulting in permanent immunosuppression or requiring permanent immunosuppressive therapy or primary immunodeficiency disorder. Low-dose steroids (=\< 10 mg daily of prednisone equivalent) is allowed
• •Seizure disorder requiring therapy (such as steroids or anti-epileptics)
• •Autologous hematopoietic stem cell transplant (HSCT) =\< 100 days prior or any prior allogeneic HSCT or solid organ transplantation
• •Known human immunodeficiency virus (HIV) infection
• •Exposed to live or live attenuated vaccine =\< 4 weeks prior to registration
• •Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
• •* Pregnant persons
• •* Nursing persons
• •* Persons of childbearing potential who are unwilling to employ adequate contraception
• •Patient has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the patient (e.g., compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments
• •Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• •Uncontrolled intercurrent illness including, but not limited to:
• •* ongoing or active infection
• •* uncontrolled infection requiring ongoing antibiotics
• •* symptomatic congestive heart failure
• •* unstable angina pectoris
• •* cardiac arrhythmia
• •* or psychiatric illness/social situations that would limit compliance with study requirements
• •* known substance abuse disorder
• •Known hypersensitivity to pembrolizumab
• •Major surgery other than diagnostic surgery =\< 4 weeks prior to registration
• •Prior radiation therapy =\< 2 weeks prior to registration or who has not recovered from all radiation-related toxicities, not require corticosteroids, and not have had radiation pneumonitis. Note: A 1-week washout is permitted for palliative radiation (=\< 2 weeks of radiotherapy) to non-CNS disease
• •Active autoimmune disease such as Crohn's disease, rheumatoid arthritis, Sjogren's disease, systemic lupus erythematosus, or similar conditions requiring systemic treatment =\< the past 3 months or a documented history of clinically severe autoimmune disease/syndrome difficult to control in the past.
• •EXCEPTIONS:
• •Vitiligo or resolved childhood asthma/atopy
• •Intermittent use of bronchodilators or local steroid injections
• •Hypothyroidism stable on hormone replacement,
• •Diabetes stable with current management
• •History of positive Coombs test but no evidence of hemolysis
• •Psoriasis not requiring systemic treatment
• •Conditions not expected to recur in the absence of an external trigger
• •* Has a known history of hepatitis B (defined as hepatitis B surface antigen \[HBsAg\] reactive) or known active hepatitis C virus (HCV) (defined as HCV ribonucleic acid \[RNA\] is detected) infection
• •* Prior anti CD47 therapy
• •* Active use of anticoagulant like warfarin. Use of low molecular weight heparin and factor Xa inhibitors will be permitted on case by case basis. There will be no restriction for daily aspirin \< 81mg daily