Clinical Trials /

CD123-Directed Autologous T-Cell Therapy for Acute Myelogenous Leukemia (CATCHAML)

NCT04318678

Description:

The CD123-CAR T-cell therapy is a new treatment that is being investigated for treatment of AML, T-ALL, B-ALL or BPDCN. The purpose of this study is to find the maximum (highest) dose of CD123-CAR T cells that is safe to give to these patients. This would include studying the side effects of the chemotherapy, as well as the CD123-CAR T-cell product on the recipient's body, disease and overall survival. Primary Objective To determine the safety of one intravenous infusion of escalating doses of autologous, CD123-CAR T cells in patients (≤21 years) with recurrent/refractory CD123+ disease (AML, B-ALL, T-ALL or BPDCN) after lymphodepleting chemotherapy. Secondary Objectives To evaluate the antileukemia activity of CD123-CAR T cells. Exploratory Objectives - To assess the immunophenotype, clonal structure and endogenous repertoire of CD123-CAR T cells and unmodified T cells - To characterize the cytokine profile in the peripheral blood and CSF after treatment with CD123-CAR T cells - To characterize tumor cells post CD123-CAR T-cell therapy

Related Conditions:
  • Acute Myeloid Leukemia
  • B-Cell Acute Lymphoblastic Leukemia
  • Blastic Plasmacytoid Dendritic Cell Neoplasm
  • T-Cell Acute Lymphoblastic Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: CD123-Directed Autologous T-Cell Therapy for Acute Myelogenous Leukemia (CATCHAML)
  • Official Title: CD123-Directed Autologous T-Cell Therapy for Acute Myelogenous Leukemia (CATCHAML)

Clinical Trial IDs

  • ORG STUDY ID: CATCHAML
  • NCT ID: NCT04318678

Conditions

  • AML
  • B-ALL
  • T-ALL
  • BPDCN

Interventions

DrugSynonymsArms
CD123-CAR TCD123-CAR T cellsCD123-CAR T cell therapy
CyclophosphamideCytoxanCD123-CAR T cell therapy
FludarabineFludaraCD123-CAR T cell therapy
MesnaCD123-CAR T cell therapy
RituximabRituxanCD123-CAR T cell therapy

Purpose

The CD123-CAR T-cell therapy is a new treatment that is being investigated for treatment of AML, T-ALL, B-ALL or BPDCN. The purpose of this study is to find the maximum (highest) dose of CD123-CAR T cells that is safe to give to these patients. This would include studying the side effects of the chemotherapy, as well as the CD123-CAR T-cell product on the recipient's body, disease and overall survival. Primary Objective To determine the safety of one intravenous infusion of escalating doses of autologous, CD123-CAR T cells in patients (≤21 years) with recurrent/refractory CD123+ disease (AML, B-ALL, T-ALL or BPDCN) after lymphodepleting chemotherapy. Secondary Objectives To evaluate the antileukemia activity of CD123-CAR T cells. Exploratory Objectives - To assess the immunophenotype, clonal structure and endogenous repertoire of CD123-CAR T cells and unmodified T cells - To characterize the cytokine profile in the peripheral blood and CSF after treatment with CD123-CAR T cells - To characterize tumor cells post CD123-CAR T-cell therapy

Detailed Description

      This study will evaluate the safety and maximum tolerated dose of CD123-CAR T cells.

      This study contains 2 phases.The first part is the called the "Collection and Manufacturing
      Phase" and the second is the "Treatment Phase".

      The Collection and Manufacturing Phase refers to your blood cells being collected and
      possibly frozen, via a process called apheresis. These cells will then be changed to improve
      their ability to recognize and kill cancer cells.

      The Treatment Phase refers to the portion of the study in which you receive an infusion of
      the CD123-CAR T cells that were made in the Collection and Manufacturing Phase; chemotherapy
      is given for several days prior to the cellular infusion. You are then monitored for any
      possible side effects.

      .

      Chemotherapy is given to get your body ready to accept the CATCHAML treatment.

      Treatment Schedule:

      Patients will receive lymphodepleting chemotherapy followed by infusion of CD123-CAR T cells

      Fludarabine on day -4, -3 and -2

      Cyclophosphamide on day -3 and -2

      REST DAY on day -1

      CD123-CAR T cell infusion on day 0 or +1
    

Trial Arms

NameTypeDescriptionInterventions
CD123-CAR T cell therapyOtherCD123-CAR T-cell dose and infusion Up to 4 Dose levels will be evaluated with a maximum dose of 2.5 x 10^8 CAR+ T cells. If dose limiting toxicities (DLTs) are observed on Dose level 1 then the cell dose is de- escalated.
  • CD123-CAR T
  • Cyclophosphamide
  • Fludarabine
  • Mesna
  • Rituximab

Eligibility Criteria

        Inclusion Criteria for Procurement and T-cell Production:

          -  Age ≤21 years old

          -  Relapsed/refractory CD123+ disease defined as follows:

        AML

          -  Relapsed disease: Patients developing recurrent disease after a first complete
             remission (CR)

          -  Refractory disease: Patients not achieving a CR after 2 cycles of induction
             chemotherapy

        B-cell ALL

          -  Relapsed disease that is CD123 positive and CD19 negative/dim or patients otherwise
             ineligible for CD19 directed therapies including

               -  Patients in 2nd or greater relapse

               -  Patients with relapse after allogeneic HSCT

          -  Refractory disease that is CD123 positive and CD19 negative/dim or patients otherwise
             ineligible for CD19 directed therapies

        T-cell All • Relapsed refractory disease that is CD123 positive

        BPDCN

        • Relapsed/refractory disease that has failed front-line therapy

          -  Estimated life expectancy of >12 weeks

          -  Karnofsky or Lansky (age-dependent) performance score ≥50

          -  Patients with a history of prior allogeneic HCT must be clinically recovered from
             prior HCT therapy, have no evidence of active GVHD and have not received a donor
             lymphocyte infusion (DLI) within the 28 days prior to apheresis

          -  Patient must have an identified, suitable HCT donor

          -  For females of child-bearing age:

          -  Not lactating with intent to breastfeed

          -  Not pregnant with negative serum pregnancy test within 7 days prior to enrollment

          -  Meets eligibility criteria to undergo autologous apheresis, or have previously
             undergone autologous apheresis

        Exclusion Criteria:

          -  Known primary immunodeficiency

          -  History of HIV infection

          -  Severe intercurrent uncontrolled bacterial, viral or fungal infection (e.g. active
             hepatitis B or C infection or adenovirus infection)

          -  History of hypersensitivity reactions to murine protein-containing products

          -  Patients with acute promyelocytic leukemia (APL, t (15;17))

          -  Known contraindication to the protocol defined lymphodepleting chemotherapy regimen of
             fludarabine/cyclophosphamide.

        Inclusion Criteria for Treatment:

          -  Age≤21 years old

          -  Detectable disease that is CD123+ (at least MRD+ disease)

          -  Estimated life expectancy of >8 weeks

          -  Karnofsky or Lansky (age-dependent) performance score≥50

          -  Patients with a history of prior allogeneic HCT must be clinically recovered from
             prior HCT therapy, have no evidence of active GVHD and have not received a donor
             lymphocyte infusion (DLI) within the 28 days prior to planned infusion

          -  Patient must have an identified, suitable HCT donor

          -  Adequate cardiac function defined as left ventricular ejection fraction >40%, or
             shortening fraction ≥25%

          -  EKG without evidence of clinically significant arrhythmia

          -  Adequate renal function defined as creatinine clearance or radioisotope GFR ≥50
             ml/min/1.73m2 (GFR ≥40 ml/min/1.73m2 if < 2 years of age)

          -  Adequate pulmonary function defined as forced vital capacity (FVC)≥50% of predicted
             value; or pulse oximetry≥92% on room air if patient is unable to perform pulmonary
             function testing

          -  Total Bilirubin≤3 times the upper limit of normal for age, except in subjects with
             Gilbert's syndrome

          -  Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤5 times the upper
             limit of normal for age

          -  Has recovered from all NCI CTAE grade III-IV, non-hematologic acute toxicities from
             prior therapy

          -  For females of child-bearing age

               -  Not lactating with intent to breastfeed

               -  Not pregnant with negative serum pregnancy test within 7 days prior to enrollment

          -  If sexually active, agreement to use birth control until 3 months after T- cell
             infusion. Male partners should use a condom.

          -  Available autologous transduced T-cell product that has met GMP release criteria

        Exclusion Criteria:

          -  Known primary immunodeficiency

          -  History of HIV infection

          -  Severe intercurrent uncontrolled bacterial, viral or fungal infection

          -  History of hypersensitivity reactions to murine protein-containing products

          -  History of severe hypersensitivity reactions to cornstarch or hydroxyethyl starch.

          -  Receiving systemic steroids therapy exceeding the equivalent of 0.5 mg/kg/day of
             methylprednisolone, in the 7 days prior to CD123-CAR T- cell infusion

          -  Receiving systemic therapy in the 14 days prior to CD123-CAR T-cell infusion, which
             will interfere with the activity of the CD123-CAR T cells in vivo (in the opinion of
             the study PI(s))

          -  Receiving rituximab therapy in the 30 days prior to CD123-CAR T cell infusion. (This
             exclusion criterion is intended to prevent premature exposure of CD123-CAR Tcells to
             rituximab, which would activate the safety switch and promote CAR T-cell apoptosis).

          -  Receiving intrathecal chemotherapy in the 7 days prior to CD123-CAR T cell infusion.

          -  Known contraindication to the protocol defined lymphodepleting chemotherapy regimen of
             fludarabine/cyclophosphamide.

          -  Active CNS disease
      
Maximum Eligible Age:21 Years
Minimum Eligible Age:N/A
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated dose of CD123-CAR T cells (CATCHAML)
Time Frame:4 weeks after CD123-CAR T-cell infusion
Safety Issue:
Description:A phase I design to determine the maximum tolerated dose (MTD) of autologous, CD123- CAR T cells. Four dose levels (3x10^5/kg, 1x10^6/kg, 3x10^6/kg, and 1x10^7/kg) will be evaluated.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:St. Jude Children's Research Hospital

Trial Keywords

  • CD123+

Last Updated

August 13, 2021