Description:
This study aims to evaluate the safety, efficacy and duration of response of CD19 Chimeric
Antigen Receptor (CAR) redirected autologous T-cells in children with high risk, relapsed
CD19+ haematological malignancies.
Title
- Brief Title: CARPALL: Immunotherapy With CD19 CAR T-cells for CD19+ Haematological Malignancies
- Official Title: Immunotherapy With CD19 CAR Redirected T-cells for High Risk, Relapsed Paediatric CD19+ Acute Lymphoblastic Leukaemia and Other Haematological Malignancies
Clinical Trial IDs
- ORG STUDY ID:
UCL 14/0529
- NCT ID:
NCT02443831
Conditions
- Acute Lymphoblastic Leukemia
- Burkitt Lymphoma
Interventions
Drug | Synonyms | Arms |
---|
Lymphodepletion with fludarabine | | CD19 CAR T-cells |
Lymphodepletion with cyclophosphamide | | CD19 CAR T-cells |
CD19 CAR T-cells | | CD19 CAR T-cells |
Purpose
This study aims to evaluate the safety, efficacy and duration of response of CD19 Chimeric
Antigen Receptor (CAR) redirected autologous T-cells in children with high risk, relapsed
CD19+ haematological malignancies.
Detailed Description
This is a multi-centre, non-randomised, open label Phase I clinical trial of an Advanced
Therapy Investigational Medicinal Product named CD19 Chimeric Antigen Receptor (CAR) T-cells
(CD19 CAR T-cells) in children and young adults (age <24 years) with high risk, relapsed
CD19+ haematological malignancies (Acute Lymphoblastic Leukemia and Burkitt's lymphoma).
Following informed consent and registration to the trial, patients will undergo an
unstimulated leukapheresis for the generation of the CD19 CAR T-cells. Patients will receive
the CD19CAR T-cells following lymphodepleting chemotherapy. The study will evaluate the
safety, efficacy and duration of response of the CD19 CAR T-cells in children with high risk
relapsed CD19+ malignancies.
Trial Arms
Name | Type | Description | Interventions |
---|
CD19 CAR T-cells | Experimental | Patients meeting the eligibility criteria will have leukapheresis to isolate the blood immune cells used to manufacture the CD19CAR T-cells. Patients will receive lymphodepletion with fludarabine and cyclophosphamide prior to infusion of the CD19CAR T-cells. | - Lymphodepletion with fludarabine
- Lymphodepletion with cyclophosphamide
- CD19 CAR T-cells
|
Eligibility Criteria
Inclusion Criteria:
1. Children and young adults (age 24 years or younger) with high risk/relapsed CD19+
haematological malignancy:
1. Resistant disease (>25% blasts) at end of UKALL 2011 or equivalent induction
2. ALL with persistent high level MRD at 2nd time point of frontline national
protocol (currently > 5 x 10-3 at week 14 UKALL2011 or equivalent)
3. High risk infant ALL (age < 6 months at diagnosis with MLL gene rearrangement and
either presenting white cell count > 300 x 109/L or poor steroid early response
(i.e circulating blast count >1x109/L following 7 day steroid pre-phase of
Interfant 06)
4. Intermediate risk infant ALL with MRD > 10-3 at end of Interfant06 induction
5. Very early (< 18 months from diagnosis) bone marrow or extramedullary relapse of
acute lymphoblastic leukaemia (ALL)
6. Early (within 6 months of finishing therapy) bone marrow, or combined
extramedullary relapse of ALL with bone marrow minimal residual disease (MRD) >
10-3 at end of re-induction
7. Any on therapy relapse of ALL in patients age 16-24
8. Any relapse of infant ALL
9. ALL post ≥ 2nd relapse
10. Any refractory relapse of ALL
11. ALL with MRD >10-4 prior to planned stem cell transplant
12. Any relapse of ALL eligible for stem cell transplant but no available HLA matched
donor or other contraindication to transplant
13. Any relapse of ALL after stem cell transplant
14. Any relapse of Burkitt's or other CD19+ lymphoma
2. Agreement to have a pregnancy test, use adequate contraception (if applicable)
3. Written informed consent
Exclusion Criteria:
- Exclusion Criteria for registration:
1. CD19 negative disease
2. Active hepatitis B, C or HIV infection
3. Oxygen saturation ≤ 90% on air
4. Bilirubin > 3 x upper limit of normal
5. Creatinine > 3 x upper limit of normal
6. Women who are pregnant or lactating
7. Stem Cell Transplant patients only: active acute graft-versus-host disease (GVHD)
overall Grade ≥ II (Seattle criteria) or moderate/severe chronic GVHD (NIH
consensus criteria) requiring systemic steroids
8. Inability to tolerate leucapheresis
9. Karnofsky (age ≥ 10 years) or Lansky (age < 10) score ≤ 50%
Exclusion criteria for CD19CAR T-cell infusion:
1. Severe intercurrent infection at the time of scheduled CD19CAR T-cell infusion
2. Requirement for supplementary oxygen or active pulmonary infiltrates at the time of
scheduled CD19CAR T-cell infusion
3. Allogeneic transplant recipients with active acute GVHD overall grade >2 or
moderate/severe chronic GVHD requiring systemic steroids at the time of scheduled
CD19CAR T-cell infusion
Maximum Eligible Age: | 24 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Toxicity evaluation following CD19CAR T-cell infusion |
Time Frame: | 1 month |
Safety Issue: | |
Description: | The incidence of grade 3-5 toxicity occurring within 60 days of CD19CAR T-cell infusion. In particular, the incidence of Severe Cytokine Release Syndrome and Grade 3-5 neurotoxicity occurring within 30 days of CD19CAR T-cell infusion. |
Secondary Outcome Measures
Measure: | Long term molecular remission |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Number of patients in molecular remission without further therapy at 2 years |
Measure: | Frequency of circulating CD19 CAR T-cells |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Persistence and frequency of circulating CD19CAR T-cells in the peripheral blood by flow cytometry and qPCR analyses. |
Measure: | Incidence of hypogammaglobulinaemia |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Incidence and duration of hypogammaglobulinaemia |
Measure: | Relapse rate |
Time Frame: | 10 years |
Safety Issue: | |
Description: | Relapse rate monitored during interventional phase and long term follow up for a total of10 years post cell infusion. Number of patients who relapsed can be summarized as a percentage or rate(for all patients registered to the trial, and also only for those who received the cell infusion). |
Measure: | Overall Survival |
Time Frame: | 10 years |
Safety Issue: | |
Description: | Overall survival is monitored during interventional phase and long term follow up for 10 years post-CD19CAR T-cell infusion. Number of patients alive can be summarized as a percentage (for all patients registered to the trial, and also only for those who received the cell infusion). |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University College, London |
Trial Keywords
- high risk relapsed CD19+ hematological malignancies
Last Updated
November 13, 2020