CAR T cells (SC-CAR4BRAIN) for the Treatment of Diffuse Intrinsic Pontine Glioma, Diffuse Midline Glioma, or Recurrent or Refractory Central Nervous System Tumors in Children and Young Adult Patients

Inclusion Criteria

• Subjects must be age >= 1 and =< 26 years (except for the first 3 subjects, who must be age >= 12 and =< 26 years)
• Subject disease classified as one of the following: * DIPG at any timepoint following completion of standard radiotherapy * DMG at any timepoint following completion of standard radiotherapy * Evidence of refractory or recurrent CNS disease for which there is no routine therapy, defined by either of the following: ** New site or sites of measurable or evaluable disease by radiographic imaging or histologic confirmation following completion of routine care first-line therapy for which curative salvage therapy is not available or amenable, OR ** Measurable or evaluable disease that persists following completion of routine care first-line therapy for which curative salvage therapy is not available or amenable
• Histopathological confirmation of primary malignant CNS tumor at either the time of diagnosis or recurrence (except for subjects with DIPG or with marker [+] CNS germ cell tumors)
• Able to tolerate apheresis or already has an apheresis product available for use in manufacturing
• CNS reservoir catheter, such as an Ommaya or Rickham catheter, present in the proper location for CNS-directed therapy delivered as specified for BrainChild-04
• Life expectancy >= 8 weeks
• Lansky or Karnofsky score >= 60. Subjects who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for purposes of assessing performance status
• If subject does not have a previously obtained apheresis product that is acceptable and available for manufacturing of CAR T cells, subject must discontinue all anticancer agents and radiotherapy and, in the opinion of the investigator, have fully recovered from significant acute toxic effects of the following: * Cytotoxic chemotherapy/biologic therapy: All cytotoxic chemotherapy/biologic therapy must be discontinued >= 7 days prior to enrollment * Antibody therapy: All anti-tumor antibody therapy must be discontinued >= 30 days or 3 half-lives (whichever is shorter) prior to enrollment. The last dose of bevacizumab may be given >= 7 days prior to enrollment * Cellular therapy: All cellular therapy must be discontinued >= 30 days prior to enrollment * Corticosteroids: All systemically administered (i.e. subcutaneous, intramuscular, orally [PO] or intravenously [IV]) corticosteroids (unless physiologic replacement dosing) must be stable or decreasing for >= 1 week prior to enrollment, with a maximum dexamethasone dose of 2.5 mg/m^2/day ongoing at enrollment. Corticosteroid physiologic replacement therapy for management of pituitary/adrenal axis insufficiency and/or topical administration (e.g. inhaled or dermatologic) is allowed
• Absolute lymphocyte count (ALC) >= 100 cells/uL * Value not required to be met if subject has previously obtained apheresis product acceptable and available for manufacturing CAR T cells
• Absolute neutrophil count (ANC) >= 500 cells/uL
• Hemoglobin >= 9 g/dL * Subjects receiving blood product transfusion(s) are acceptable as long as they are not determined to be transfusion refractory
• Platelets >= 100,000/uL * Subjects receiving blood product transfusion(s) are acceptable as long as they are not determined to be transfusion refractory
• Adequate renal function, as indicated by serum creatinine =< the upper limit of normal (ULN) per: * Serum creatinine (mg/dL) ULN: ** Age 1 to < 2 years (yrs): 0.6 (male), 0.6 (female) ** Age 2 to < 6 yrs: 0.8 (male), 0.8 (female) ** Age 6 to < 10 yrs: 1 (male), 1 (female) ** Age 10 to < 13 yrs: 1.2 (male), 1.2 (female) ** Age 13 to < 16 yrs: 1.5 (male), 1.4 (female) ** Age >= 16 yrs: 1.7 (male), 1.4 (female)
• Adequate hepatic function as indicated by either of the following: * Total bilirubin < 3 times ULN for age, OR * Conjugated bilirubin < 2 mg/dL
• Oxygen saturation >= 90% on room air without supplemental oxygen or mechanical ventilation
• No dyspnea at rest
• Signs and symptoms of neurologic deficit must be stable for >= 1 week prior to enrollment
• =< two anti-epileptic agents are required to control seizure activity
• No clinically evident encephalopathy present
• Virology negative within 3 months prior to enrollment, to include all of the following: * Human immunodeficiency virus (HIV) antigen & antibody, AND * Hepatitis B surface antigen, AND * Hepatitis C antibody OR if antibody positive, hepatitis C polymerase chain reaction (PCR) is negative
• Subjects of childbearing/fathering potential must agree to use highly effective contraception from the time of enrollment through 12 months following the last T cell infusion

Exclusion Criteria

• Presence of >= grade 3 cardiac dysfunction or symptomatic arrhythmia requiring intervention
• Presence of primary immunodeficiency/bone marrow failure syndrome
• Presence of clinical and/or radiographic evidence of impending herniation in the CNS
• For arm A subjects only: Presence of > grade 3 dysphagia
• Presence of active malignancy other than the CNS tumor under study
• Presence of active severe infection, defined as either of the following: * Positive blood culture within 48 hours of enrollment, OR * Fever > 38.2 degrees Celsius (C) AND clinical signs of infection within 48 hours of enrollment
• Pregnant or breastfeeding
• Subject and/or authorized legal representative unwilling to provide consent/assent for study participation, including participation in the 15-year follow-up period, which is required if CAR T cell therapy is administered
• Presence of any condition that, in the opinion of the investigator, would prohibit the subject from undergoing treatment under this protocol