Genetically Engineered Cells (19-28z/IL-18 CAR T Cells) for the Treatment of Relapsed or Refractory Acute Lymphoblastic Leukemia

Inclusion Criteria

• Patients must have R/R ALL meeting one of the following criteria: * For Philadelphia chromosome negative (Ph-negative) B acute lymphoblastic leukemia (B-ALL): Refractory or relapsed disease to at least 1 prior multiagent systemic chemotherapy regimen that included both induction and consolidation therapy * For Philadelphia chromosome positive (Ph+positive) B-ALL: patients must have exhibited persistent or progressive disease following at least 1 prior second- or third-generation tyrosine kinase inhibitor
• Signed informed consent form (ICF) prior to any study procedures
• Age: The first 3 patients enrolled into the study will be ≥ 17 years of age at time of enrollment. If a dose-limiting toxicity (DLT) is observed, the additional 3 patients in this cohort will also be ≥ 17 years of age. Additional patients will be ≥ 12 years of age at time of enrollment
• Documentation of CD19 positivity on leukemia blasts if prior anti-CD19 treatment
• History of prior allogeneic hematopoietic stem cell transplant (HSCT) is allowed if >= 3 months from time of enrollment and no evidence of acute or chronic graft versus host disease (GVHD) within 4 weeks prior to enrollment
• Donor lymphocyte infusions (DLI) permitted if ≥ 4 weeks prior to leukapheresis
• History of secondary central nervous system (CNS) or meningeal involvement allowed if: * Cannot be the only site of disease * Absence of neurologic symptoms, such as: seizures, stroke-like deficits, altered mental status, aphasia, or psychosis
• Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 5 x upper limit of normal (ULN) (at time of screening)
• Total bilirubin ≤ 2 (or ≤ 3 if history of Gilbert's syndrome or leukemic infiltration of the liver) (at time of screening)
• Serum creatinine < 2.0mg/100mL (at time of screening)
• Oxygen saturation (SaO2) ≥ 92% on room air (at time of screening)
• Left ventricular ejection fraction (LVEF) ≥ 50% within 1 month of screening
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1 or Lansky performance status ≥ 60 for patients < 16 years old
• Prior CD19-targeted therapies (including CD19 CAR-T cell and CD19 bispecific T-cell engagers) are allowed including anti-CD19 CAR T therapy, as long as CD19 positivity is confirmed on most recent bone marrow or tumor biopsy

Exclusion Criteria

• Concurrent active malignancy excluding: nonmelanoma skin cancer or localized solid tumor that has undergone definitive therapy and with low risk of recurrence, e.g., prostate, breast
• Burkitt’s leukemia or lymphoma or chronic myeloid leukemia (CML) in lymphoid blast crisis
• Radiologically detected or symptomatic CNS disease or CNS 3 disease (i.e., presence of ≥ 5/uL white blood cells [WBCs] in cerebrospinal fluid [CSF]). Subjects with adequately treated CNS leukemia are eligible
• The following medications are excluded: * Steroids: Therapeutic doses of corticosteroids (greater than 10mg daily of prednisone or its equivalent) within 7 days of leukapheresis or 72 hours prior to CAR T cell infusion * Chemotherapy: Should be stopped one week prior to leukapheresis or starting lymphodepleting chemotherapy. Hydroxyurea for cytoreduction can be administered up to 72 hours before leukapheresis or CAR T cell infusion
• History of class III-IV New York Heart Association (NYHA) heart failure, cardiac angioplasty or stenting, myocardial infarction, unstable angina, or other clinically significant cardiac condition within 6 months of screening
• Patients with history of significant autoimmune disease and/or inflammatory condition affecting the CNS are ineligible
• Systemic treatment for GVHD within 4 weeks prior to enrollment
• Patients with known severe autoimmune disease (e.g., Crohn’s, rheumatoid arthritis, or lupus) that in the investigator’s opinion has high likelihood of requiring systemic immune suppressive medications
• Patients with HIV infection
• Patients with active hepatitis B infection (as manifested by either detectable hepatitis B virus deoxyribonucleic acid [DNA] by polymerase chain reaction [PCR] and/or positivity for hepatitis B surface antigen)
• Patients with active hepatitis C infection (as manifested by detectable hepatitis C virus ribonucleic acid [RNA] by PCR)
• Patients with uncontrolled systemic fungal, bacterial, viral or other infection including COVID-19 at time of leukapheresis or at time of CAR T cell infusion. For those patients who have had a recent COVID-19 infection, at least 4 weeks should be passed before the COVID-19 infection date and CAR T cell infusion
• Other uncontrolled medical or psychological conditions as well as social or logistical issues that may interfere with compliance with the protocol, as determined by the investigator
• Treatment with live, attenuated vaccine < 4 weeks prior to leukapheresis
• Pregnant or lactating/breastfeeding women