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Study to Evaluate the Role of Siltuximab in Treatment of Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity (ICANS) Related to CAR-T Cell Therapy

NCT04975555

Description:

This study will evaluate the use of siltuximab to decrease the severity of cytokine release syndrome (CRS) and immune effector cell-associated neurological syndrome (ICANS) in patients who will receive chimeric antigen receptor (CAR) T-cell therapy for the treatment of hematological malignancies.

Related Conditions:
  • Acute Lymphoblastic Leukemia
  • Diffuse Large B-Cell Lymphoma
  • Follicular Lymphoma
  • High Grade B-Cell Lymphoma, Not Otherwise Specified
  • Mantle Cell Lymphoma
  • Multiple Myeloma
  • Primary Mediastinal B-Cell Lymphoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study to Evaluate the Role of Siltuximab in Treatment of Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity (ICANS) Related to CAR-T Cell Therapy
  • Official Title: A Phase II Pilot Study to Evaluate the Role of Siltuximab in Treatment of Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity (ICANS) Related to Chimeric Antigen Receptor T-Cell Therapy (CAR-T) in Hematological Malignancies

Clinical Trial IDs

  • ORG STUDY ID: IRB-300007103
  • NCT ID: NCT04975555

Conditions

  • Cytokine Release Syndrome
  • ICANS
  • Lymphoma, Non-Hodgkin
  • Multiple Myeloma
  • Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
SiltuximabSiltuximab

Purpose

This study will evaluate the use of siltuximab to decrease the severity of cytokine release syndrome (CRS) and immune effector cell-associated neurological syndrome (ICANS) in patients who will receive chimeric antigen receptor (CAR) T-cell therapy for the treatment of hematological malignancies.

Detailed Description

      Patients eligible to receive CAR T-cell therapy for FDA-approved indications in hematological
      malignancies will be enrolled in this study on the day of CAR T-cell infusion. Patients will
      be followed until they develop grade 1 or higher CRS and/or ICANS. On developing these
      syndromes, siltuximab will be administered with close monitoring and follow-up for resolution
      of symptoms. If symptoms continue to worsen, then an additional dose of siltuximab will be
      given. If the symptoms leading to CRS do not resolve, then rescue tocilizumab will be
      administered. The study's primary endpoint is to assess the response rate of siltuximab in
      the resolution of CRS within 14 days. The study's secondary endpoint is to assess the
      response rate of siltuximab in the resolution of ICANS, the safety of siltuximab, and the
      overall response rate of CAR T-cell therapy.
    

Trial Arms

NameTypeDescriptionInterventions
SiltuximabExperimentalPatients who experience CRS/ICANS will receive this treatment
  • Siltuximab

Eligibility Criteria

        Inclusion Criteria:

          -  Patients who are planned to receive chimeric antigen receptor T-cell therapy as per
             the United States Food and Drug Agency (USFDA) approved indications for Diffuse large
             B-cell lymphoma (DLBCL), Mantle cell lymphoma (MCL), Follicular lymphoma (FL), Primary
             mediastinal large B-cell lymphoma (PMBCL), High grade B-cell lymphoma, DLBCL arising
             from follicular lymphoma, Multiple myeloma and B-cell precursor acute lymphoblastic
             leukemia

          -  Patients with hepatitis C virus (HCV) can be included if they have completed therapy
             for hepatitis C with undetectable HCV RNA viral load.

          -  Patients with Hepatitis B can be included if they are on suppressive therapy for
             hepatitis B infection and with no detectable viral load.

          -  Adequate organ function as defined below unless attributed to disease
             involvement.Acceptable window for assessing adequate organ function is 7 days to 30
             days before planned CAR T-cell infusion with day 0 as the planned day of CAR T-cell
             infusion.Adequate liver function (bilirubin < 2mg/dL, aspartate aminotransferase (AST)
             and/or alanine aminotransferase (ALT) <3 x ULN), adequate kidney function (crcl >
             30ml/min using Cockcroft-Gault, based on actual weight) and adequate hematological
             parameters (Absolute neutrophil count ≥ 1,000/µL, Hemoglobin > 8, Platelet Count ≥
             50,000/ µL)

          -  Patients able to tolerate washout periods for therapies prior to CAR T-cell infusion.
             Systemic therapy: Washout period is 2 weeks prior to CAR T-cell infusion. Radiation
             therapy: Washout period is 1 week prior to CAR T-cell infusion. Corticosteroids: The
             washout period is 5 days prior to CAR T-cell infusion.

          -  A negative urine pregnancy test is required within 1 week for all women of
             childbearing potential prior to enrolling on this trial.

          -  For females of reproductive potential: use of highly effective contraception for at
             least 1 month prior to screening and agreement to use such a method during study
             participation and for an additional 4 months after infusion of siltuximab.

          -  For males of reproductive potential: use of condoms or other methods to ensure
             effective contraception with partner

          -  Willing and able to participate in all required evaluations and procedures in this
             study protocol including receiving intravenous administration of the investigational
             product and being admitted, when required, for at least 24 hours during
             investigational product administration.

        Exclusion Criteria:

          -  Subjects requiring ongoing daily corticosteroid therapy at a dose of > 10 mg of
             prednisone per day (or equivalent). Pulsed corticosteroid use for disease control is
             acceptable.

          -  Active autoimmune disease requiring immunosuppressive therapy is excluded unless
             discussed with the principal investigator (PI)

          -  Pregnant women are excluded from this study.

          -  Evidence of ongoing systemic bacterial, or fungal or viral infection, except localized
             fungal infection of skin or nails.

          -  Patients with ongoing or past HIV infection.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Participants with a complete response for cytokine release syndrome (CRS)
Time Frame:Baseline through 14 days
Safety Issue:
Description:Participants who achieve a resolution of CRS. Resolution of CRS is defined as absence of symptoms leading to diagnosis of CRS for 24 hours.

Secondary Outcome Measures

Measure:Participants with a response for Immune effector Cell Associated Neurotoxicity Syndrome (ICANS)
Time Frame:Baseline through 28 days
Safety Issue:
Description:Participants who achieve a resolution or improvement in their ICANS. Complete response or partial response for ICANS is defined as either complete disappearance or decrease in the grade of severity as measured by ASTCT Consensus Grading for ICANS. The ASTCT grade is from 1 to 5 for ICANS with 1 being mild symptoms and 5 being severe symptoms.
Measure:Participants experiencing adverse events from Siltuximab
Time Frame:Baseline through 28 days
Safety Issue:
Description:All Adverse Events (AE's) will be reported and evaluated using National Cancer Institute's Common Terminology Criteria (CTCAE) v5.0.
Measure:Participants with response to CAR T-cell therapy
Time Frame:Baseline through day 90
Safety Issue:
Description:This will be measured by using specific criteria's for Lymphoma, Multiple Myeloma or Acute Lymphoblastic Leukemia (ALL) [Based on the patients diagnosis]

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:University of Alabama at Birmingham

Trial Keywords

  • Siltuximab
  • Chimeric Antigen Receptor T-cell Therapy
  • Cytokine release syndrome
  • Immune effector Cell associated Neurotoxicity Syndrome
  • Lymphoma
  • Multiple Myeloma
  • Acute lymphoblastic Leukemia

Last Updated

August 13, 2021