This phase I trial investigates the best dose and side effects of 19(T2)28z1xx chimeric antigen receptor (CAR) T cells in treating patients with B-cell cancers that have come back after a period of improvement (relapsed) or do not respond to treatment (refractory). 19(T2)28z1xx CAR T cells are made in the laboratory using the patient's collected white blood cells (T cells). T cells are important protective cells of the immune system. The T cells have been genetically modified (changes are made to the DNA or genes) to help them identify, fight, or kill cancer cells. A virus (retrovirus) is used to introduce a gene that creates a protein (called a chimeric antigen receptor or CAR) on the surface of T cells to identify and kill cancer cells. The retrovirus then becomes inactive. The 19(T2)28z1xx CAR T cells can recognize a protein called CD19, which is found on the surface of B-cell cancer cells, and destroy those cells. The purpose of this trial is to test the safety of 19(T2)28z1xx CAR T cells in patients with relapsed/refractory B-cell cancers.
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT04464200.
PRIMARY OBJECTIVES:
I. To estimate the safety and tolerability of autologous anti-CD19 CAR T-cells 19(T2)28z1xx (19(T2)28z1XX) in treatment of relapsed/refractory (R/R) large cell lymphoma.
II. To identify the recommended phase II dose (RP2D) of 19(T2)28z1XX.
SECONDARY OBJECTIVES:
I. To estimate the efficacy of 19(T2)28z1XX in patients treated at recommended phase 2 dose (RP2D) as measured by the overall response rate (ORR), complete response (CR) rate, and progression-free survival (PFS).
II. To estimate the in vivo expansion and persistence of 19(T2)28z1XX CAR T cells in patients treated at RP2D.
EXPLORATORY OBJECTIVES:
I. To assess the development and duration of B cell aplasia in patients treated at RP2D.
II. To assess the level of minimal residual disease (MRD) following the modified T cell infusions in patients treated at RP2D.
III. To assess the T cell phenotype of persisting 19(T2)28z1XX CAR T cells in patients treated at RP2D.
IV. To summarize the proinflammatory and immune-suppressive cytokines across the study time points in patients treated at RP2D.
V. To assess any anti-CAR antibody generation in patients treated at all dose levels of 19(T2)28z1XX.
OUTLINE: This is a dose-escalation study of 19(T2)28z1xx.
CONDITIONING CHEMOTHERAPY: Patients receive cyclophosphamide intravenously (IV) and fludarabine IV over 3 hours daily on days -5 to -3.
CAR T INFUSION: 2-7 days after completion of conditioning chemotherapy, patients receive 19(T2)28z1XX CAR T cells IV over 1-3 days depending on dose level. Patients undergo positron emission tomography (PET) and/or computed tomography (CT).
After the completion of study treatment, patients are followed up weekly for 1 month, monthly for 5 months, at 12 months, then annually for up to 15 years.
Lead OrganizationMemorial Sloan Kettering Cancer Center
Principal InvestigatorJae Park