Genetically Engineered Cells (UCD19 CAR-T Cells) for the Treatment of Recurrent or Refractory B-cell Acute Lymphoblastic Leukemia or B-cell Non-Hodgkin Lymphoma
This phase I/II trial studies the side effects and best dose of UCD19 chimeric antigen receptor (CAR)-T cells in treating patients with B-cell acute lymphoblastic leukemia or B-cell non-Hodgkin lymphoma that has come back (recurrent) or has not been responding to treatment (refractory). T cells are immune cells involved in fighting infections and can kill cancer cells. In this study, some T cells are removed from patients' blood and are modified in the laboratory by putting a new gene into the T cells that may allow them to then recognize and attempt to kill the cancer cells before being given back to the patients.
Inclusion Criteria
- Meets criteria for potential leukapheresis collection or has leukapheresis product previously collected and stored per recommended guidelines
- Provision of signed and dated consent form from parent or guardian (patients < 18), the patient themselves (> 18), or legally authorized representative (patient >18 who lack decision-making capacity); Pediatric patients will be included in age-appropriate discussions and assent will be obtained for those > 7 years of age, when appropriate, according to institutional standards.
- Willingness to participate in long term follow up study
- Stated willingness to comply with all study procedures and be available for the duration of the study
- Males OR non-pregnant, non-breastfeeding females * Patients of child-bearing potential or capable of fathering a child must agree to use highly effective contraception from the time of initial CAR T cell administration though 12 months following the final administration of investigational product
- Aged 31 days to 30 years (inclusive) at time of consent and enrollment
- Acute lymphoblastic leukemia (ALL) OR non-Hodgkin lymphoma (NHL) of B-cell origin that: * Has confirmed expression of CD19 by flow cytometry, immunohistochemistry (IHC), or both * COHORT ONE CRITERIA: ** Meets any one of the following conditions: *** Relapsed two or more times *** Relapsed at any time after allogeneic bone marrow transplant (BMT) *** Refractory to standard therapy as determined by the treating physician *** Meets criteria for BMT but is ineligible as determined by the treating physician *** Patient and/or parents declining BMT options and would prefer CAR-T Therapy ** Non-Hodgkin lymphoma includes all of the following: *** Diffuse large B-cell lymphoma (DLBCL) *** Burkitt lymphoma *** Intermediate lymphoma between Burkitt and DLBCL *** Primary mediastinal B-cell lymphoma (PMBL) *** Follicular lymphoma *** High grade B cell lymphoma *** Transformed lymphoma * COHORT TWO CRITERIA: ** B-ALL in first relapse with any one of the following conditions: *** High-risk genomic alterations at initial diagnosis such as KMT2A gene rearrangement, t(17;19), hypodiploidy, Ph-like mutations, BCR-ABL1 fusion (Ph+ ALL), iAMP21, and TP53 inactivating mutation/deletion *** Isolated CNS relapse such that cranial radiation would be indicated as a component of standard salvage therapy *** Down syndrome *** Minimal residual disease (MRD) positivity of > 0.01% by fluorescence activated cell sorting (FACS) or > 0 clonal sequences by next generation sequencing (NGS) in bone marrow post re-induction chemotherapy *** Age 18 years or older. OR ** Newly diagnosed with persistent MRD ≥ 0.01% by flow cytometry in bone marrow at end of consolidation.
- Performance score (Lansky or Karnofsy) of 50% or better
- Unable to or declined to receive commercially available CD19 CAR-T therapy
Exclusion Criteria
- Evidence of rapidly progressive disease without adequate salvage/bridging regimens as determined by the investigator.
- Active graft-versus-host disease (GvHD)
- Active, uncontrolled, life threatening infection that at the determination of the treating physician would preclude safe apheresis or tolerance of lymphodepleting chemotherapy, cell infusion, or cytokine release syndrome
- Evidence of severe organ dysfunction as defined by: * Myocardial dysfunction: Ejection fraction ≤ 40% or shortening fraction ≤ 28%, evidence of physiologically significant pericardial effusion as determined by an echocardiogram (ECHO), and clinically significant electrocardiogram (ECG) findings * Baseline oxygen saturation of ≤ 90% on room air * Transaminases > 10 x upper limit of normal (ULN) or bilirubin > 2 x the ULN, unless thought to be related to primary disease * Estimated creatinine (Cr) clearance < 60 mL/min/1.73 m^2 (if nuclear medicine glomerular filtration rate [GFR] or other more specific testing exceeds this level than it can supersede the estimated clearance)
- Post-pubertal females that are pregnant, planning to become pregnant, or unwilling to use birth control (includes abstinence) for the study duration
- Known human immunodeficiency virus (HIV) infection, or active hepatitis B or active hepatitis C infection
- Prior gene therapy, including prior CAR-T cell
Additional locations may be listed on ClinicalTrials.gov for NCT04544592.
Locations matching your search criteria
United States
Colorado
Aurora
PRIMARY OBJECTIVE:
I. To determine the safety and tolerability of CD19CAR-CD3zeta-4-1BB-expressing allogeneic T-lymphocyte cells (UCD19 CAR-T) infusion in pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL) or B-cell non-Hodgkin lymphoma (B-NHL). (Phase I)
II. To determine the preliminary efficacy of UCD19 CAR-T infusion in pediatric patients with B-ALL or B-NHL. (Phase II)
SECONDARY/EXPLORATORY OBJECTIVES:
I. To determine the preliminary efficacy of UCD19 CAR-T cells in pediatric patients with B-ALL during the expansion phase.
II. To determine the preliminary efficacy of UCD19 CAR-T infusion in pediatric patients after first relapse with B-ALL during the expansion phase.
III. To Determine the feasibility of UCD19 CAR-T manufacturing and infusion.
OUTLINE: This is a phase I, dose-escalation study of UCD19 CAR-T cells followed by a phase II study.
Patients receive cyclophosphamide intravenously (IV) on days -5 and -4 and fludarabine IV on days -5 to -2. Patients then receive UCD19 CAR-T cells IV over up to 30 minutes on day 0 in the absence of disease progression or unacceptable toxicity. Patients who have residual malignancy after the first infusion of UCD19 CAR-T cells may receive a second infusion with or without cyclophosphamide and fludarabine per physician discretion. Patients additionally undergo blood sample collection, bone marrow aspiration and/or biopsy, lumbar puncture, positron emission tomography (PET), computed tomography (CT) and echocardiography (ECHO) or multigated acquisition scan (MUGA) on study.
After completion of study treatment, patients are followed for up to 15 years.
Trial PhasePhase I/II
Trial Typetreatment
Lead OrganizationChildren's Hospital Colorado
Principal InvestigatorVanessa Ann Fabrizio
- Primary ID18-2424.cc
- Secondary IDsNCI-2020-08490
- ClinicalTrials.gov IDNCT04544592