Description:
This is an open-label, four-cohort, phase 2 study to determine the efficacy of CART19 in
pediatric and young adult patientswith hypodiploid (Cohort A) or t(17;19) B-ALL (Cohort B),
infants with very high risk KMT2A B-ALL (Cohort C), and in patients with central nervous
system (CNS) relapse who did not receive cranial radiation (XRT) or bone marrow
transplantation (BMT) (Cohort D).
Title
- Brief Title: Phase 2 Trial of CD19 Redirected Autologous T Cells
- Official Title: Phase 2 Trial of CD19-Directed Chimeric Antigen Receptor CD19 Redirected Autologous T Cells (CART19) for Orphan Indications of Pediatric B Cell Acute Lymphoblastic Leukemia (B ALL)
Clinical Trial IDs
- ORG STUDY ID:
834653, 19CT023, 19-016979
- NCT ID:
NCT04276870
Conditions
- Pediatric and Young Adult Patientswith Hypodiploid or t(17;19) B-ALL
- Infants With Very High Risk KMT2A B-ALL
- Patients With Central Nervous System Relapse Who Did Not Receive Cranial Radiation or Bone Marrow Transplantation
Interventions
Drug | Synonyms | Arms |
---|
Murine CART19 | | Infant subjects with very high risk KMT2A B-ALL |
Purpose
This is an open-label, four-cohort, phase 2 study to determine the efficacy of CART19 in
pediatric and young adult patientswith hypodiploid (Cohort A) or t(17;19) B-ALL (Cohort B),
infants with very high risk KMT2A B-ALL (Cohort C), and in patients with central nervous
system (CNS) relapse who did not receive cranial radiation (XRT) or bone marrow
transplantation (BMT) (Cohort D).
Trial Arms
Name | Type | Description | Interventions |
---|
Subjects with hypodiploid B-ALL | Experimental | | |
Subjects with t(17;19) B-ALL | Experimental | | |
Infant subjects with very high risk KMT2A B-ALL | Experimental | | |
Subjects with central nervous system (CNS) relapse who did not | Experimental | | |
Eligibility Criteria
Inclusion Criteria:
1. Signed informed consent form must be obtained prior to any study procedure.
2. Male and female patients with documented CD19+ B-ALL
a.Cohort A & B: Patients, regardless their response to initial or relapsed B ALL
therapy, with the following characteristics: i.Cohort A: Subjects with confirmation of
a hypodiploid karyotype (chromosome number fewer than 45) ii.Cohort B: Subjects with
cytogenetic confirmation of the chromosomal translocation t(17;19) (Cohort B) b.Cohort
C: Infants w/ newly diagnosed KMT2A rearranged B-ALL classified as very high risk by
the following criteria: i.Age < 3 months at diagnosis ii.Age < 6 months and WBC >
300,000x109/L at diagnosis or a poor prednisone response in induction iii.MRD positive
> 0.01 (or PCR > 104) after 2 courses of standard infant ALL therapy.
c.Cohort D: Subjects in a first or greater CNS relapse, prior to therapy with cranial
XRT or HSCT for the current relapse
3. Expression of CD19 on leukemic blasts demonstrated by flow cytometry of bone marrow,
cerebrospinal fluid, or peripheral blood
4. Age 0 to 29 years
5. Adequate organ function defined as:
1. A serum creatinine based on age/gender as follows:
Maximum Serum Creatinine (mg/dL) Age Male Female 0 to < 2 years 0.6 0.6 2 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. Adequate liver function:
i.ALT≤ 5 x ULN; ALT ii.Total bilirubin ≤ 3 x ULN iii.ALT and/or bilirubin results that
exceed this range are acceptable if, in the opinion of the physician-investigator (or
as confirmed by liver biopsy), the abnormalities are directly related to ALL
infiltration of the liver.
c.Must have a minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea and <
Grade 3 hypoxia; DLCO ≥ 40% (corrected for anemia) if PFTs are clinically appropriate
as determined by the physician-investigator.
d.Left Ventricular Shortening Fraction (LVSF) ≥ 28%, or Left Ventricular Ejection
Fraction (LVEF) ≥ 45% by echocardiogram. In cases where quanitative assessment of
LVSF/LVEF is not possible, a statement by the cardiologist that the ECHO shows
qualititatively normal ventricular function wll suffice.
6. Adequate performance status defined as Lansky or Karnofsky score ≥ 50
7. Subjects of reproductive potential must agree to use acceptable birth control methods
Exclusion Criteria:
1. For subjects with a CNS relapse, prior cranial XRT or BMT for the current relapse is
an exclusion.
2. Active hepatitis B or active hepatitis C.
3. HIV Infection.
4. Active acute or chronic graft-versus-host disease (GVHD) requiring systemic therapy.
5. Concurrent use of systemic steroids at the time of cell infusion or cell collection,
or a condition, in the treating physician's opinion, that is likely to require steroid
therapy during collection or after infusion. Steroids for disease treatment at times
other than cell collection or at the time of infusion are permitted. Use of
physiologic replacement hydrocortisone or inhaled steroids is permitted as well.
6. CNS3 disease that is progressive on therapy, or with CNS parenchymal lesions that
might increase the risk of CNS toxicity.
7. Pregnant or nursing (lactating) women.
8. Uncontrolled active infection.
Maximum Eligible Age: | 29 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Event-free survival (EFS) |
Time Frame: | One year |
Safety Issue: | |
Description: | 1 year event-free survival (EFS), where events include no response, relapse, death due to any cause |
Secondary Outcome Measures
Measure: | EFS Rate 1 |
Time Frame: | One year |
Safety Issue: | |
Description: | Modified EFS rate in CNS relapse patients, using a definition of events that includes no response, relapse, death, need for XRT or need for BMT |
Measure: | To further evaluate the safety of CART19 in the target patient populations |
Time Frame: | One year |
Safety Issue: | |
Description: | Frequency and severity of adverse events |
Measure: | EFS rate 2 |
Time Frame: | One year |
Safety Issue: | |
Description: | Modified EFS rate in patients with early CNS relapsed B-ALL (CR1 <18 months) and those with late CNS relapsed B-ALL (CR1 >18 months) using a definition of events that includes no response, relapse, death, need for XRT or need for BMT |
Measure: | MRD conversion |
Time Frame: | One year |
Safety Issue: | |
Description: | Rate of MRD conversion to less than 0.01% (in patients with MRD) 28 days after CART19 therapy in patients with t(17;19) B-ALL, hypodiploid B-ALL, and very high risk infant B-ALL |
Measure: | Relapse Free survival 1 |
Time Frame: | One year |
Safety Issue: | |
Description: | Relapse-free survival (RFS) at one year in patients with hypodiploid B-ALL, patients with t(17;19) B-ALL, and very high risk infant B-ALL regardless of their initial response to B-ALL therapy and in patients with CNS relapse who did not receive cranial XRT or BMT after CART19 and who achieved a complete remission following CART19 therapy. |
Measure: | Relapse Free survival 2 |
Time Frame: | One year |
Safety Issue: | |
Description: | RFS at one year in patients with hypodiploid B-ALL who were MRD negative at end of induction and those who were MRD positive at end of induction during upfront therapy |
Measure: | Relapse Free survival 3 |
Time Frame: | One year |
Safety Issue: | |
Description: | RFS at one year in patients with t(17;19) B-ALL who were MRD negative at end of induction and those who were MRD positive at end of induction during upfront therapy |
Measure: | Relapse Free survival 4 |
Time Frame: | One year |
Safety Issue: | |
Description: | RFS at one year in very high risk infants with KMT2A rearrangement who were MRD negative at end of induction and those who were MRD positive at end of induction. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University of Pennsylvania |
Last Updated
June 9, 2021