Clinical Trials /

CAR-20/19-T Cells in Pediatric Patients With Relapsed/Refractory B Cell ALL

NCT04049383

Description:

This is a phase 1, interventional, open label, treatment study designed to evaluate the safety and feasibility of infusion of CAR-20/19-T in pediatric and young adult subjects with B cell ALL that have relapsed after prior therapies or refractory disease and are not candidates for curative intent standard therapy. There will be two phases of this study. A dose escalation phase to determine the safe CAR-20/19-T cell dose in patients B-cell ALL. Once the desired dose has been identified there will be a 6-patient dose expansion phase at the specified dose level.

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

Not yet recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: CAR-20/19-T Cells in Pediatric Patients With Relapsed/Refractory B Cell ALL
  • Official Title: Phase 1 Study of Redirected Autologous T Cells Engineered to Contain an Anti-CD19 and Anti-CD20 scFv Coupled to CD3ζ and 4-1BB Signaling Domains in Pediatric and Young Adult Patients With Relapsed and/or Refractory CD19 or CD20 B-cell Acute Lymphoblastic Leukemia

Clinical Trial IDs

  • ORG STUDY ID: CAR-20/19-T
  • NCT ID: NCT04049383

Conditions

  • Acute Lymphoblastic Leukemia, in Relapse
  • Acute Lymphoblastic Leukemia With Failed Remission
  • Acute Lymphoblastic Leukemia Recurrent
  • Acute Lymphoblastic Leukemia Not Having Achieved Remission
  • Acute Lymphoblastic Leukemia, Pediatric
  • Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
CAR-20/19-T cellsDose Escalation Phase

Purpose

This is a phase 1, interventional, open label, treatment study designed to evaluate the safety and feasibility of infusion of CAR-20/19-T in pediatric and young adult subjects with B cell ALL that have relapsed after prior therapies or refractory disease and are not candidates for curative intent standard therapy. There will be two phases of this study. A dose escalation phase to determine the safe CAR-20/19-T cell dose in patients B-cell ALL. Once the desired dose has been identified there will be a 6-patient dose expansion phase at the specified dose level.

Trial Arms

NameTypeDescriptionInterventions
Dose Escalation PhaseExperimental
  • CAR-20/19-T cells
Dose Expansion PhaseExperimental
  • CAR-20/19-T cells

Eligibility Criteria

        Inclusion Criteria:

          1. Diagnosis of B-cell ALL: Patients must be aged ≥ 1 years and ≤ 39.99 years with
             relapsed or refractory disease and no available curative options that meet clinical
             criteria to initiate treatment.

          2. Relapsed or refractory B cell ALL defined as one of the following:

               1. Primary refractory disease

               2. Relapsed or refractory disease after 2 or more lines of systemic therapy

               3. Relapsed or refractory disease after allogeneic transplant provided subject is at
                  least 100 days from stem cell transplant at the time of enrollment and off of
                  immunosuppressive medications for at least 4 weeks prior to enrollment

          3. Morphological disease in the bone marrow (> 5% blasts).

          4. Patients with B-cell ALL must have either CD19 or CD20 positive disease on their most
             recent bone marrow performed. A minimum of 5% CD19 and/or CD20 positivity on prior or
             bone marrow aspirate (BMA) or biopsy is required.

          5. Subjects with Ph+ ALL are eligible if they have relapsed or have refractory disease
             and have failed two tyrosine kinase inhibitors.

          6. Absolute CD3+ T cell count ≥100/mm3.

             a. Subjects who receive chemotherapy and/or steroids after CD3+ T-cell count, but
             before apheresis, will require this test to be repeated.

          7. Lumbar puncture with CSF analysis by cytology with no evidence of disease.

          8. Karnofsky/Lansky performance score ≥70. See Appendix A for scales.

          9. Normal Baseline Neurological Evaluation: Mini-Mental Status Exam Score 24-30 for > 16
             yo (Appendix B).

         10. Adequate hepatic function, defined as AST and ALT <3 x upper limit of normal (ULN);
             serum bilirubin and alkaline phosphatase <2 x ULN, or considered not clinically
             significant as per the clinical PIs discretion (e.g. Gilbert's or indirect
             hyperbilirubinemia) or felt to be due to underlying disease.

         11. Adequate renal function defined as creatinine clearance or radioisotope GFR > 70
             ml/min/1.73 M2

         12. Able to give informed consent if > 18 years, or with a legal guardian capable of
             giving informed consent if < 18 years.

         13. Agree to practice birth control during the study.

         14. Cardiac ejection fraction ≥ 50%, no evidence of pericardial effusion as determined by
             an ECHO.

         15. No clinically significant arrhythmias.

         16. Adequate pulmonary function as indicated by room air oxygen saturation of ≥ 92% and no
             clinically significant pleural effusion.

         17. Expected survival >12 weeks.

         18. Negative urine or serum pregnancy test in females of child bearing potential at study
             entry and again within 48 hours' prior lymphodepleting chemotherapy.

         19. Patients with prior CD19 or CD20 therapy (e.g., blinatumomab, CART19, rituximab)
             treatment require repeat BMA/biopsy post-CD19 or CD20 therapy treatment that
             demonstrates CD19 or CD20 positive disease.

         20. Meet criteria regarding fertility and contraception detailed in section 4.4.

         21. Central line access will be required for CAR-20/19-T cell infusion.

        Exclusion Criteria:

          1. Positive beta-HCG in female of child-bearing potential defined as per table 1.

          2. Patients with known systemic allergy to bovine or murine products.

          3. Confirmed active human immunodeficiency virus (HIV), Hepatitis B or C infection. A
             history of hepatitis B or hepatitis C is permitted if the viral load is undetectable
             per quantitative PCR and/or nucleic acid testing.

          4. History of significant autoimmune disease OR active, uncontrolled autoimmune
             phenomenon: such as systemic lupus erythematous, Wegner's glomerulonephritis,
             autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura (AIHA, ITP) requiring
             steroid therapy defined as >20 mg of prednisone.

          5. Presence of ≥ grade 3 non-hematologic toxicities as per CTCAE version 5 from any
             previous treatment unless it is felt to be due to underlying disease.

          6. Concurrent use of investigational therapeutic agents or enrollment on another
             therapeutic clinical trial at any institution.

          7. Refusal to participate in the long-term follow-up protocol.

          8. CNS Abnormalities

               1. Patients with prior CNS disease that has been effectively treated will be
                  eligible providing treatment was >4 weeks before enrollment and a remission
                  documented within 4 weeks of planned CAR-T cell infusion. Patients will be
                  excluded if they have any signs of neurotoxicity at baseline or evidence of
                  chloroma or leukemic infiltrates on MRI.

               2. Presence of CNS-3 disease defined as detectable cerebrospinal blast cells in a
                  sample of CSF with ≥ 5 WBCs per mm3 with or without neurological changes, and
                  presence of CNS-2 disease defined as detectable cerebrospinal blast cells in a
                  sample of CSF with < 5 WBCs per mm3 with neurological changes Note: Subjects with
                  CNS-1 (no detectable leukemia in the CSF) and those with CNS-2 without clinically
                  evident neurological changes are eligible to participate in the study.

               3. History or presence of any CNS disorder, such as a seizure disorder,
                  cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, any autoimmune
                  disease with CNS involvement, posterior reversible encephalopathy syndrome
                  (PRES), or cerebral edema

          9. Previous recipients of allogeneic hematopoietic stem cell transplantation (AHCT) are
             excluded if they are <100 days' post-transplant, have evidence of active
             graft-versus-host-disease (GVHD) of any grade, or are currently on immunosuppression.

         10. Anti-CD20 antibody treatment within 4 weeks of cell infusion.

         11. Anti-CD19 antibody treatment within 4 weeks of cell infusion

         12. Cytotoxic chemotherapy other than lymphodepletion within 14 days of CAR-T cell
             infusion.

         13. Cytotoxic chemotherapy treatment within 14 days or steroid treatment (other than
             replacement dose steroids) within 7 days prior to apheresis collection for CAR-T
             cells. TKIs must be held for 5 half lives or 7 days whichever is shorter prior to
             enrollment.

         14. Patients post solid organ transplant who develop high grade lymphomas or leukemias.

         15. Concurrent active malignancy (exceptions: treated solid malignancy in >5 years'
             remission, treated basal or squamous cell carcinomas of the skin).

         16. History of concomitant genetic syndrome associated with bone marrow failure such as
             Fanconi anemia, Kostmann syndrome, or Shwachman-Diamond syndrome
      
Maximum Eligible Age:39 Years
Minimum Eligible Age:1 Year
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Determine the safety (dose level) of CAR-20/19-T cell administration in relapsed refractory B-ALL.
Time Frame:40 months
Safety Issue:
Description:Safety will be determined by assessments of CRS using the Lee et al. grading scale [1] and adverse events via NCI CTCAE version 5.0. Response assessment occur initially at Day +28 post-treatment (+/- 3 days) with CAR-20/19-T cells. Ongoing response assessment will continue until progression and/or death up to 2 years (see Table 1), after which patients will be transitioned to a long-term follow-up protocol.

Secondary Outcome Measures

Measure:Determine the anti-tumor responses as measured by response rates.
Time Frame:40 months
Safety Issue:
Description:
Measure:Describe the duration of response for responding patients.
Time Frame:40 months
Safety Issue:
Description:
Measure:Determine persistence of CAR-20/19-T cells.
Time Frame:40 months
Safety Issue:
Description:
Measure:Determine the effects of CAR-20/19-T infusion on non-neoplastic CD19 & CD20 B cells in vivo.
Time Frame:40 months
Safety Issue:
Description:
Measure:Evaluate MRD using molecular technologies.
Time Frame:40 months
Safety Issue:
Description:

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Medical College of Wisconsin

Trial Keywords

  • ALL, B-cell, CAR-T

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