Description:
Patients eligible for this study have a type of blood cancer Acute Myeloid Leukemia (AML)
which has come back or has not gone away after treatment.
The body has different ways of fighting disease and infection, and this research study
combines two different ways of fighting cancer with antibodies and T cells with the hope that
they will work together. T cells (also called T lymphocytes) are special infection-fighting
blood cells that can kill other cells including tumor cells. Antibodies are types of proteins
that protect the body from bacterial and other infectious diseases. Both antibodies and T
cells have been used to treat patients with cancers; they have shown promise, but have not
been strong enough to cure most patients when used alone.
T lymphocytes can kill tumor cells but there normally are not enough of them to kill all the
tumor cells. Some researchers have taken T cells from a person's blood, grown more of them in
the laboratory and then given them back to the person. The antibody used in this study
targets CLL-1. This antibody sticks to AML cells because of a substance (protein) on the
outside of these cells called CLL-1. For this study, the antibody to CLL-1 has been changed
so that instead of floating free in the blood, it is now joined to the T cells. When T-cells
contain an antibody that is joined to them, they are called chimeric antigen receptor T-cells
or CAR-T cells.
In the laboratory, the investigators have also found that T cells work better if proteins
that stimulate T cells are also added, such as one called CD28. Adding the CD28 makes the
cells grow better and last longer in the body, thus giving the cells a better chance of
killing the leukemia or lymphoma cells. In this study we are going to attach the CLL-1
chimeric receptor that has CD28 added to it to the patient's T cells. We will then test how
long the cells last.
These CLL-1 chimeric antigen receptor T cells with CD28 are investigational products not
approved by the Food and Drug Administration.
Title
- Brief Title: Chimeric Antigen Receptor T-cells for The Treatment of AML Expressing CLL-1 Antigen
- Official Title: Chimeric Antigen Receptor T-cells for The Treatment of Acute Myeloid Leukemia Expressing CLL-1 Antigen
Clinical Trial IDs
- ORG STUDY ID:
H-43516-CARMEN
- NCT ID:
NCT04219163
Conditions
Interventions
Drug | Synonyms | Arms |
---|
CLL-1.CAR T cells | | CLL-1.CAR |
Purpose
Patients eligible for this study have a type of blood cancer Acute Myeloid Leukemia (AML)
which has come back or has not gone away after treatment.
The body has different ways of fighting disease and infection, and this research study
combines two different ways of fighting cancer with antibodies and T cells with the hope that
they will work together. T cells (also called T lymphocytes) are special infection-fighting
blood cells that can kill other cells including tumor cells. Antibodies are types of proteins
that protect the body from bacterial and other infectious diseases. Both antibodies and T
cells have been used to treat patients with cancers; they have shown promise, but have not
been strong enough to cure most patients when used alone.
T lymphocytes can kill tumor cells but there normally are not enough of them to kill all the
tumor cells. Some researchers have taken T cells from a person's blood, grown more of them in
the laboratory and then given them back to the person. The antibody used in this study
targets CLL-1. This antibody sticks to AML cells because of a substance (protein) on the
outside of these cells called CLL-1. For this study, the antibody to CLL-1 has been changed
so that instead of floating free in the blood, it is now joined to the T cells. When T-cells
contain an antibody that is joined to them, they are called chimeric antigen receptor T-cells
or CAR-T cells.
In the laboratory, the investigators have also found that T cells work better if proteins
that stimulate T cells are also added, such as one called CD28. Adding the CD28 makes the
cells grow better and last longer in the body, thus giving the cells a better chance of
killing the leukemia or lymphoma cells. In this study we are going to attach the CLL-1
chimeric receptor that has CD28 added to it to the patient's T cells. We will then test how
long the cells last.
These CLL-1 chimeric antigen receptor T cells with CD28 are investigational products not
approved by the Food and Drug Administration.
Detailed Description
To make the CLL1-CD28 chimeric antigen receptor T cells, the investigators will collect the
patient's blood and stimulate them with growth factors to make the cells grow. To get the
CLL-1 antibody and CD28 to attach to the surface of the T cell, we put the antibody gene into
the T cell. This is done using a virus called a retrovirus that has been made for this study
and will carry the antibody gene into the T cell. This virus also helps investigators find
the T cells in the patient's blood after they are injected. Because the patient will have
received cells with a new gene in them the patient will be followed for a total of 15 years
to see if there are any long term side effects of gene transfer.
When the patient enrolls on this study, the patient will be assigned a dose of CLL-1 chimeric
antigen receptor- T cells. Several studies suggest that the T cells that we give to the
patient need room to be able to grow and work well and that this may not happen if there are
too many other T cells already in circulation the patient's body. Because of that, the
patient will receive two chemotherapy medications before receiving the CLL-1 chimeric antigen
receptor- T cells.
One medication is called cyclophosphamide and the other fludarabine. The patient will receive
3 daily doses of each drug, ending at least one day before receiving the chimeric antigen
receptor- T cells. These drugs will lower the numbers of the patient's T cells before we give
them the CLL-1 chimeric antigen receptor T cells and will also help lower the number of other
cells that may block the chimeric antigen receptor- T cells from working well. Although we do
not expect any effect on the patient's cancer with the doses that will be received, these
drugs are part of many treatment plans that are used to treat leukemia.
Patients will be given an injection of cells into the vein through an IV at the assigned
dose. The injection will take from 1 to 10 minutes. Before patients receive the injection,
they may be given a dose of Benadryl and Tylenol. The treatment will be given by the Center
for Cell and Gene Therapy at Texas Children's Hospital or Houston Methodist Hospital.
Investigators will monitor patients in the clinic after the injection for up to 3 hours, and
they will have to remain locally for at least 3 weeks after the infusion. If patients have
any side effects, they may have to be admitted to the hospital for evaluation and management.
If after a 4 week evaluation period following the infusion, the patient has achieved a
complete response, his/her cancer doctors may decide if you should go on to have a bone
marrow transplant, at which time the patient will be removed from the treatment portion of
the study.
BEFORE BEING TREATED, PATIENTS WILL RECEIVE A SERIES OF STANDARD MEDICAL TESTS:
- Physical exam and History
- Blood tests to measure blood cells, kidney and liver function
- Pregnancy test for female patients who are of child bearing potential -Measurements of
your tumor by bone marrow studies
- Imaging such as PET scans, CT scans or MRIs will be obtained if needed
PATIENTS WILL RECEIVE STANDARD MEDICAL TESTS DURING TREATMENT AND AFTER:
- Physical exams and History
- Blood tests to measure blood cells, kidney and liver function
- Measurements of your tumor by bone marrow studies 4-6 weeks after the infusion, possibly
12 weeks after the infusion and then per standard of care.
- Imaging such as PET scans, CT scans or MRIs will be obtained if needed 4-6 weeks
following the infusion
To learn more about the way the CLL-1 chimeric receptor-T cells are working and how long they
last in the body, extra blood will be drawn. The total amount on any day is about 10
teaspoons (50 mL) or no more than 3 mL per 2.2 pounds body weight in children. This amount is
considered safe but may be lowered if you are anemic. This blood may be taken from a central
line if you have one. Blood will be taken before the chemotherapy drugs, several hours after
the T cell infusion, at 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, and 8 weeks after the
infusion, at 3 months, 6 months, 9 months, at 1 year, every 6 months for 4 years, then yearly
for a total of 15 years.
If patients have a bone marrow exam while they are on this study, we may ask to have a sample
of bone marrow to look for CLL-1 chimeric receptor- T cells.
If a patient decides to withdraw at any time during the study, both samples and data
collected during his/her participation will be kept.
Trial Arms
Name | Type | Description | Interventions |
---|
CLL-1.CAR | Experimental | Group A | |
Eligibility Criteria
PROCUREMENT
Inclusion Criteria:
1. Diagnosis of primary refractory or relapsed Acute Myeloid Leukemia (AML) AND suitable
for consideration of allogeneic Hematopoietic Stem Cell Transplant with confirmation
of an identified eligible donor by a FACT accredited transplant center and with
confirmation that the center plans to proceed with transplant if CLL-1.CAR treatment
induces response they consider adequate to proceed to allogeneic HSCT
2. CLL-1 positive tumor with at least 30% CLL-1 blasts by flow cytometry or
immunohistochemistry (tissue) assessed by a CLIA certified Flow Cytometry/Pathology
laboratory
3. Age ≤75 years NOTE: The first six (6) patients treated on the study will be adults
(≥18 yrs of age).
4. Hgb ≥ 7.0 g/dL(can be transfused)
5. Life expectancy greater than 12 wks
6. If apheresis required to collect blood
- PT and APTT <1.5x ULN
- Serum Creatinine < 1.5 x ULN
- AST < 1.5 x ULN
7. Informed consent
Exclusion Criteria:
1. Active infection (bacterial, fungal or viral) requiring ongoing treatment without
improvement.
2. Active infection with HIV or HTLV
3. Active second cancer (except non-melanoma skin cancer or in situ breast cancer or
cervix cancer)or other cancer treated ≤ 2 years prior to enrollment
4. Ongoing treatment with immune suppression for prophylaxis or treatment of GVHD
including high dose steroids (eg prednisone > 0.25mg/kg)
-
TREATMENT
Inclusion Criteria:
1. Diagnosis of primary refractory or relapsed Acute Myeloid Leukemia (AML). Patients
with targetable mutations should have failed or be ineligible for targeted therapies
(e.g. FLT3 inhibitors, IDH inhibitors, or anti-CD33 drug conjugate). AND patients
should be suitable for consideration of allogeneic Hematopoietic Stem Cell Transplant
with confirmation of an identified eligible donor by a FACT accredited transplant
center and with confirmation that the center plans to proceed with transplant if
CLL-1.CAR treatment induces a response they consider adequate to proceed to allogeneic
HSCT.
2. CLL-1 positive tumor with at least 30% CLL-1 blasts by flow cytometry or
immunohistochemistry (tissue) assessed by a CLIA certified Flow Cytometry/Pathology
laboratory
3. Age ≤75 years NOTE: The first six (6) patients treated on the study will be adults
(≥18 yrs of age).
4. AST/ALT less than 5 times the upper limit of normal
5. Bilirubin less than 3 times the upper limit of normal
6. Estimated GFR ≥ 60ml/min
7. Pulse oximetry of > 92% on room air
8. Karnofsky/Lansky ≥ 60
9. Recovered from all acute toxic effects of prior chemotherapy at least one week before
study entry and off systemic chemotherapy at least 2 weeks prior to study entry
10. Available autologous transduced activated peripheral blood T-cell product with ≥ 20%
expression of CLL-1.CAR.28z by flow cytometry
11. Life expectancy > 12 weeks
12. Sexually active patients must be willing to utilize one of the more effective birth
control methods during the study and for 6 months after the study is concluded. The
male partner should use a condom
13. Informed consent explained to, understood by, and signed by patient/guardian.
Patient/guardian given copy of informed consent.
Exclusion Criteria:
1. Currently receiving any investigational agents or having received any tumor vaccines
within the previous 6 weeks.
2. History of hypersensitivity reactions to murine protein-containing products.
3. Pregnant or lactating.
4. Active infection with HIV or HTLV.
5. Clinically significant bacterial, viral or fungal infection requiring ongoing
antifungal therapy without improvement,.
6. Cardiac criteria: Prolonged QTc with maximum interval as defined by age with ;
Uncontrolled atrial fibrillation/flutter; Myocardial infarction within the last 6
months; Cardiac echocardiography with LVSF<30% or LVEF<50% or clinically significant
pericardial effusion; Cardiac dysfunction NYHA III or IV; CNS abnormalities: Presence
of CNS disease defined as detectable cerebrospinal blast cells in a sample of CSF with
≥ 5 WBCs per mm3 or chloroma on imaging, History or presence of an underlying CNS
disorder such as a seizure disorder requiring current use of antiepileptic
medications, cerebrovascular ischemia/hemorrhage within prior 6 months, dementia,
cerebellar disease, or any autoimmune disease with CNS involvement.
7. Use of serotherapy with Campath or Anti-Thymocyte Globulin (ATG) within the last 28
days
8. Use of Donor Lymphocyte Infusion (DLI) or other cellular therapy product within 30
days
9. Acute GVHD ≥ Grade 2 or moderate to severe (formerly extensive) chronic GVHD
10. Aministration of high dose steroids >1 mg/kg within the preceding 5 days or currently
receiving > 0.25 mg/kg of Prednisone equivalent
11. Hyperleukocytosis (WBC ≥50K) or rapidly progressive disease that in the estimation of
the investigator would compromise the ability of the patient to complete the study.
Maximum Eligible Age: | 74 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose limiting toxicity (DLT) rate |
Time Frame: | 4 weeks post T cell infusion |
Safety Issue: | |
Description: | To assess dose limiting toxicities per protocol-defined CLL-1.CAR T related adverse events and CTCAE v5.0 |
Secondary Outcome Measures
Measure: | Overall Response Rate |
Time Frame: | 4 weeks post T cell infusion |
Safety Issue: | |
Description: | To measure the anti-tumor effects of CLL-1.CAR T-cells in patients with acute myeloid malignancies. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Baylor College of Medicine |
Trial Keywords
Last Updated
September 1, 2020