Clinical Trials /

Phase III B in Acute Lymphoblastic Leukemia

NCT03123939

Description:

This is a single arm, open-label, multi-center, phase III B study to determine the safety and efficacy of CTL019 in pediatric/young adult patients with r/r B-cell Acute Lymphoblastic Leukemia (ALL).

Related Conditions:
  • B-Cell Acute Lymphoblastic Leukemia
Recruiting Status:

Completed

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Phase III B in Acute Lymphoblastic Leukemia
  • Official Title: Phase IIIb Study for Relapsed/Refractory Pediatric/Young Adult Acute Lymphoblastic Leukemia Patients to be Treated With CTL019

Clinical Trial IDs

  • ORG STUDY ID: CCTL019B2001X
  • SECONDARY ID: 2016-001991-31
  • NCT ID: NCT03123939

Conditions

  • Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
CTL019CTL019

Purpose

This is a single arm, open-label, multi-center, phase III B study to determine the safety and efficacy of CTL019 in pediatric/young adult patients with r/r B-cell Acute Lymphoblastic Leukemia (ALL).

Detailed Description

      This was a single-arm, multi-centeric Phase IIIb study provided pediatric/young adult
      patients with r/r B-cell ALL the opportunity to be treated with CTL019. The main purpose of
      this study was to assess the safety of CTL019 for up to 12 months after the CTL019 infusion.
      The study had the following sequential phases for all patients: Screening including
      leukapheresis, Pre-Treatment (Cell Product Preparation and Lymphodepleting Chemotherapy),
      Treatment and Follow-up, and Long-Term Follow-Up (LTFU). The end of study (EOS) was defined
      as the last patient's last visit, which was the last patient's Month 12 evaluation, or the
      time of premature withdrawal. All patients were followed in this study for up to 12 months
      after the CTL019 infusion.
    

Trial Arms

NameTypeDescriptionInterventions
CTL019ExperimentalCTL019 transduced T cells were given as a single dose of 0.2 to 5.0 × 10^6 autologous CTL019 transduced viable T cells per kg body weight (for patients ≤ 50 kg) and 0.1 to 2.5 × 10^8 CTL019 transduced viable T cells (for patients > 50 kg)
  • CTL019

Eligibility Criteria

        Inclusion Criteria:

        Relapsed or refractory B-cell ALL in pediatric or young adult patients:

          1. Second or greater bone marrow relapse.

          2. Any bone marrow relapse after allogeneic SCT and must be ≥ 4 months from SCT at the
             time of CTL019 infusion OR

          3. Primary refractory as defined by not achieving a CR after 2 cycles of a standard
             chemotherapy regimen or chemorefractory as defined by not achieving a CR after 1 cycle
             of standard chemotherapy for relapsed leukemia OR

          4. Patients with Philadelphia chromosome positive (Ph+) ALL are eligible if they are
             intolerant to or have failed 2 lines of tyrosine kinase inhibitor (TKI) therapy, or if
             TKI therapy is contraindicated OR

          5. Ineligible for allogeneic SCT

        For relapsed patients, CD19 tumor expression demonstrated in bone marrow or peripheral
        blood by flow cytometry within 3 months of program entry.For relapsed or refractory
        patients previously treated with blinatumomab, CD19 tumor expression must be demonstrated
        (via flow cytometry) at Screening.

        Adequate organ function defined as:

          1. A serum creatinine based on age/gender as follows: Maximum Serum Creatinine (mg/dL).
             Age Male Female: to < 2 years 0.6 0.6; to < 6 years 0.8 0.8; 6 to < 10 years 1.0 1.0;
             10 to < 13 years 1.2 1.2; 13 to < 16 years 1.5 1.4; ≥ 16 years 1.7 1.4.

          2. ALT ≤ 5 times the upper limit of normal (ULN) for age.

          3. Bilirubin < 2.0 mg/dL.

          4. Minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea and pulse oxygenation
             > 91% on room air.

          5. Left Ventricular Shortening Fraction ≥ 28% by echocardiogram, or Left Ventricular
             Ejection Fraction ≥ 45% by echocardiogram or Multiple Uptake Gated Acquisition (MUGA).

        Life expectancy > 12 weeks.

        Age less than 26 at the time of screening.

        Karnofsky (age ≥16 years) or Lansky (age < 16 years) performance status ≥ 50 at screening.

        Patients previously treated with blinatumomab who have detectable leukemia and documented
        CD19+ expression (via flow cytometry) and confirmed absence of CD19- leukemic blasts at
        Screening may be included. In this case, at least 1 week washout period must be applied
        from last dose of blinatumomab to start of leukapheresis. Patients previously treated with
        blinatumomab with no detectable MRD (i.e. MRD negative demonstrated by leukemic blasts <
        0.01%) will be excluded.

        Must have a leukapheresis product of non-mobilized cells received and accepted by the
        manufacturing site.

        Patients with active CNS leukemia involvement defined as CNS-3 by CSF findings only are
        eligible but will have their CTL019 infusion delayed until CNS disease is reduced to CNS-1
        or CNS-2 by CSF findings. Patients with other forms of active CNS-3 leukemic involvement
        such as CNS parenchymal or ocular disease, cranial nerve involvement or significant
        leptomeningeal disease are not eligible. However, such patients with other forms of CNS-3
        leukemic involvement (non-CSF involvement) are eligible if there is documented evidence of
        disease stabilization for at least 3 months prior to CTL019 infusion. Patients must have no
        acute/ongoing neurologic toxicity > Grade 1 with the exception of a history of controlled
        seizures or fixed neurologic deficits that have been stable/improving over the past 3
        months.

        Exclusion criteria Isolated extra-medullary disease relapse. Concomitant genetic syndromes
        associated with bone marrow failure states: Fanconi anemia, Kostmann syndrome, Shwachman
        syndrome or any other known bone marrow failure syndrome. Patients with Down Syndrome will
        not be excluded.

        Patients with Burkitt's lymphoma/leukemia (i.e. patients with mature B-cell ALL, leukemia
        with B-cell surface immunoglobulin (sIg) positive and kappa or lambda restricted positivity
        ALL, with FAB L3 morphology and /or a MYC translocation).

        Prior malignancy, except carcinoma in situ of the skin or cervix treated with curative
        intent and with no evidence of active disease.

        Prior treatment with any gene therapy product. Prior treatment with any anti-CD19/anti-CD3
        therapy, or any other anti-CD19 therapy, except for patients pre-treated with blinatumomab
        Active or latent hepatitis B or active hepatitis C (test within 8 weeks of screening), or
        any uncontrolled infection at screening Human immunodeficiency virus (HIV) positive test
        within 8 weeks of screening. Presence of grade 2 to 4 acute or extensive chronic GVHD.
        Uncontrolled acute life threatening bacterial, viral or fungal infection at Screening
        Investigational medicinal product within the last 30 days prior to screening. Pregnant or
        nursing women.Women of child-bearing potential and all male participants, unless they are
        using highly effective methods of contraception for a period of 1 year after the CTL019
        infusion.

        The following medications are excluded:

          1. Steroids: Therapeutic systemic doses of steroids must be stopped > 72 hours prior to
             CTL019 infusion.

          2. Allogeneic cellular therapy: Any donor lymphocyte infusions must be completed > 6
             weeks prior to CTL019 infusion.

          3. GVHD therapies: Any systemic drug used for GVHD must be stopped > 4 weeks prior to
             CTL019 infusion to confirm that GVHD recurrence is not observed.

          4. Chemotherapy:

               -  TKIs and hydroxyurea must be stopped > 72 hours prior to CTL019 infusion.

               -  must be stopped > 1 week prior to CTL019 infusion: vincristine, 6-mercaptopurine,
                  6-thioguanine, methotrexate < 25 mg/m2, cytosine arabinoside < 100 mg/m2/day,
                  asparaginase (non pegylated).

               -  must be stopped > 2 weeks prior to CTL019 infusion: salvage chemotherapy (e.g.
                  clofarabine, cytosine arabinoside > 100 mg/m2, anthracyclines, cyclophosphamide,
                  methotrexate ≥ 25 mg/m2).

               -  Pegylated-asparaginase must be stopped > 4 weeks prior to CTL019 infusion.

          5. CNS disease prophylaxis: CNS prophylaxis treatment must be stopped > 1 week prior to
             CTL019 infusion (e.g. intrathecal methotrexate).

          6. Radiotherapy

               -  Non-CNS site of radiation must be completed > 2 weeks prior to CTL019 infusion.

               -  CNS directed radiation must be completed > 8 weeks prior to CTL019 infusion.

          7. Anti T-cell antibodies: Administration of any T cell lytic or toxic antibody (e.g.
             alemtuzumab) within 8 weeks prior to CTL019 is prohibited Other protocol-defined
             inclusion/exclusion may apply
      
Maximum Eligible Age:25 Years
Minimum Eligible Age:N/A
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Number of Participants With Treatment-Emergent Adverse Events (TEAEs)
Time Frame:From CTL019 infusion until end of study, up to 12 months
Safety Issue:
Description:Treatment emergent adverse events were collected from CTL019 infusion until end of study, up to 12 months

Secondary Outcome Measures

Measure:Overall Remission Rate (ORR)
Time Frame:From CTL019 infusion until Month 6
Safety Issue:
Description:ORR is defined as the proportion of participants with a best overall disease response of Complete remission (CR) or CR with incomplete blood count recovery (CRi), where the best overall disease response is defined as the best disease response recorded from CTL019 infusion until Month 6.
Measure:Number of Participants Who Achieved CR or CRi at Month 6 Without Stem Cell Transplantation (SCT)
Time Frame:Month 6
Safety Issue:
Description:Proportion of participants who achieved CR or CRi at Month 6 without stem cell transplantation between CTL019 infusion and Month 6 response assessment
Measure:Number of Participants Who Achieved CR or CRi and Then Proceeded to Stem Cell Transplantation (SCT) While in Remission Before Month 6 Assessment
Time Frame:From CTL019 infusion until Month 6
Safety Issue:
Description:Proportion of participants who achieved CR or CRi and then proceeded to stem cell transplantation while in remission prior to Month 6 response assessment.
Measure:Duration of Response (DOR)
Time Frame:Actual reported Time Frame: up to 14.4 months post CTL019 infusion (planned follow-up period per protocol was only 12 months post CTL019 infusion)
Safety Issue:
Description:DOR is the duration of remission from the date when the response criteria of CR or CRi was first met post CTL019 infusion to the date of relapse or death due to acute lymphoblastic leukemia (ALL), whichever occured first.
Measure:Relapse-free Survival (RFS)
Time Frame:Actual reported Time Frame: up to 14.4 months post CTL019 infusion (planned follow-up period per protocol was only 12 months post CTL019 infusion)
Safety Issue:
Description:RFS is measured by the time from achievement of CR or CRi whichever occured first post CTL019 infusion, to relapse or death due to any cause during CR or CRi.
Measure:Event-free Survival (EFS)
Time Frame:Actual reported Time Frame: up to 15.1 months post CTL019 infusion (planned follow-up period per protocol was only 12 months post CTL019 infusion)
Safety Issue:
Description:EFS is the time from date of CTL019 infusion to the earliest of death, relapse or treatment failure.
Measure:Overall Survival (OS)
Time Frame:Actual reported Time Frame: up to 24.4 months post CTL019 infusion (planned follow-up period per protocol was only 12 months post CTL019 infusion)
Safety Issue:
Description:OS is the time from date of CTL019 infusion to the date of death due to any reason
Measure:Number of Participants Who Attained CR or CRi at Day 28
Time Frame:Day 28
Safety Issue:
Description:Proportion of participants who attained CR or CRi at Day 28 post CTL019 infusion.
Measure:Number of Participants Who Attained CR or CRi at Day 28 by Baseline Bone Marrow Tumor Burden
Time Frame:Day 28
Safety Issue:
Description:Proportion of participants who attained CR or CRi at Day 28 post CTL019 infusion by baseline bone marrow tumor burden.
Measure:Bone Marrow Minimum Residual Disease (MRD) Status by Flow Cytometry on Day 28 Post CTL019 Infusion
Time Frame:Enrollment/Pre-chemotherapy and Day 28
Safety Issue:
Description:MRD in ALL refers to the presence of leukemic cells below the threshold of detection using conventional morphologic methods. The most frequently used methods for MRD assessment include multicolor flow cytometry to detect abnormal immunophenotypes and polymerase chain reaction (PCR) assays to detect clonal rearrangements in immunoglobulin heavy chain genes and/or T-cell receptor genes or fusion transcripts (e.g. BCR-ABL (Philadelphia chromosome)). The results include the descriptive summary of MRD qualitative result (positive/negative) before treatment and at Day 28 after treatment and before HSCT by local assessment (flow cytometry).
Measure:Bone Marrow Minimum Residual Disease (MRD) Status by qPCR on Day 28 Post CTL019 Infusion
Time Frame:Enrollment/Pre-chemotherapy and Day 28
Safety Issue:
Description:MRD in ALL refers to the presence of leukemic cells below the threshold of detection using conventional morphologic methods. The most frequently used methods for MRD assessment include multicolor flow cytometry to detect abnormal immunophenotypes and polymerase chain reaction (PCR) assays to detect clonal rearrangements in immunoglobulin heavy chain genes and/or T-cell receptor genes or fusion transcripts (e.g. BCR-ABL (Philadelphia chromosome)). The results include the descriptive summary of MRD qualitative result (positive/negative) before treatment and at Day 28 after treatment and before HSCT by local assessment (qPCR).
Measure:Incidence of Immunogenicity Against CTL019 - Humoral Immunogenicity
Time Frame:Baseline, Day 14, Day 28, Month 3, Month 6 and Month 12
Safety Issue:
Description:The humoral immunogenicity assessment included evaluation of pre-existing (pre-treatment) and post-treatment anti-CTL019 antibodies to examine the incidence of immunogenicity with treatment.
Measure:Incidence of Immunogenicity Against CTL019 - Cellular Immunogenicity
Time Frame:Baseline, Day 14, Day 28, Month 3, Month 6 and Month 12
Safety Issue:
Description:The cellular immunogenicity assessment included percentage of CD4+ and CD8+ T- cells specific for CTL019.
Measure:AUC0-28d: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28
Safety Issue:
Description:Area under the concentration-time curve of CTL019 in the peripheral blood after single dose administration from time zero to Day 28 after single dose administration as measured by qPCR.
Measure:AUC0-84d: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28 and 84
Safety Issue:
Description:Area under the concentration-time curve of CTL019 in the peripheral blood after single dose administration from time zero to Day 84 after single dose administration as measured by qPCR.
Measure:Cmax: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The maximum (peak) observed in peripheral blood drug concentration after single dose administration
Measure:Clast: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The last observed in peripheral blood drug concentration after single dose administration.
Measure:Tmax: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The time to reach maximum (peak) peripheral blood drug concentration after single dose administration.
Measure:T1/2: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The half-life associated with the elimination phase slope of a semi logarithmic concentration-time curve (days) in peripheral blood.
Measure:Tlast: PK Parameters for CTL019 by qPCR
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The time to reach the last observed quantifiable concentration in peripheral blood after single dose administration.
Measure:AUC0-28d by Maximum Cytokine Release Syndrome (CRS) Grade
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28
Safety Issue:
Description:AUC0-28d from time zero to Day 28 after single dose administration as measured by qPCR. PK results were presented by the maximum Penn Grading Scale (Grade 1 to 4): - Mild reaction - Moderate reaction - More severe reaction - Life-threatening complications
Measure:Cmax by Maximum Cytokine Release Syndrome (CRS) Grade
Time Frame:Day 1 10 min post-infusion, Day 4, 7, 11, 14, 28, Month 3, 6, 9 and 12
Safety Issue:
Description:The maximum (peak) observed in peripheral blood drug concentration after single dose administration. PK results were presented by the maximum Penn Grading Scale (Grade 1 to 4): - Mild reaction - Moderate reaction - More severe reaction - Life-threatening complications

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:Novartis Pharmaceuticals

Trial Keywords

  • ALL
  • Acute Lymphoblastic Leukemia
  • CTL019
  • relapsed/refractory pediatric/young adult

Last Updated

July 21, 2021