A Pediatric Trial of Genetically Modified Autologous T Cells Directed Against CD19 for Relapsed CD19+ Acute Lymphoblastic Leukemia

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2014 by Seattle Children's Hospital
Sponsor:
Information provided by (Responsible Party):
Rebecca Gardner, Seattle Children's Hospital
ClinicalTrials.gov Identifier:
NCT01683279
First received: September 7, 2012
Last updated: May 13, 2014
Last verified: May 2014
  Purpose

Patients with relapsed leukemia often develop resistance to chemotherapy. For this reason, we are attempting to use a patient's own T cells, which can be genetically modified to expresses a chimeric antigen receptor(CAR). The CAR enables the T cell to recognize and kill the leukemic cells though the recognition of CD19, a protein expressed on the surface of the majority of pediatric ALL. This is a phase I study designed to determine the maximum tolerated dose of the CAR+ T cells and define the toxicity of the treatment. As a secondary aim, we will be looking at the efficacy of the T cells on eradicating the patient's leukemic cells.


Condition Intervention Phase
B Cell Leukemia
Biological: Autologous CD19 CAR+ EGFTt + T cells
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Pediatric Leukemia Adoptive Therapy (PLAT)-01: A Phase 1 Feasibility and Safety Study of Cellular Immunotherapy for Relapsed Pediatric CD19+ Acute Lymphoblastic Leukemia Using Autologous T-cells Lentivirally Transduced To Express a CD19-Specific Chimeric Antigen Receptor

Resource links provided by NLM:


Further study details as provided by Seattle Children's Hospital:

Primary Outcome Measures:
  • Number of Participant with Adverse Events [ Time Frame: 42 days ] [ Designated as safety issue: Yes ]
    The safety of the T cell infusion will be described and the maximum tolerated dose determined.


Secondary Outcome Measures:
  • Persistence of the CD19 CAR+ T cells [ Time Frame: 42 days ] [ Designated as safety issue: No ]
    Patients will be followed for 42 days to determine if the transferred T cells remain detectable in the blood and bone marrow

  • Determine if there is anti-leukemic activity of the CD19 CAR+ T cells [ Time Frame: 42 days ] [ Designated as safety issue: No ]
    Patients will have their bone marrow assessed following the T cell infusion to determine if their disease responded to the treatment


Estimated Enrollment: 18
Study Start Date: December 2012
Estimated Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: CAR+ T cells Biological: Autologous CD19 CAR+ EGFTt + T cells

Detailed Description:

Upon meeting the eligibility requirements and enrolling on study, subjects will undergo a blood draw to obtain the T cells for the generation of the CD19 CAR+ T cells. The T cells are isolated from the blood, transduced with a lentivirus to express the CD19 CAR, and expanded in culture over a three week period. During the process of cell generation, subjects will continue to be cared for by their primary oncologist and may undergo additional treatment directed at the leukemia during this time.

After the CAR+ T cells have been generated, the subject undergoes a disease assessment and will be admitted to the hospital to receive 2 days of cyclophosphamide for lymphodepletion and reduction of disease burden. Several days later, the subject will receive an infusion of the CAR+ T cells.

Following treatment with the CAR+ T cells, subjects will be intensely followed for 6 weeks with serial blood testing and re-evaluation of disease status with bone marrow aspirates. After 6 weeks, the subjects clinical care will be resumed by their primary oncologist, and it is possible that they would receive additionally chemotherapy or a stem cell transplant.

Upon completion of the study, subjects will be followed at least annually with a either a medical history, physical exam and blood tests or a phone call/questionnaire for 15 years. This follow up will help to determine if the subject develops any long-term health problems related to the CAR+ T cells including a new cancer.

  Eligibility

Ages Eligible for Study:   1 Year to 26 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • CD19+ Leukemia in 1st marrow relapse with MRD at the end of 1st month of re-induction
  • CD19+ Leukemia in 2nd or greater relapse
  • CD19+ Leukemia with indication for HCT, but has contraindication
  • Age between 1 and 26 years of age
  • Karnofsky of >50 or Lansky >50
  • Life Expectancy >12 weeks
  • Able to tolerate a blood draw of 4-6mL/kg
  • Recovered from acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy
  • absolute lymphocyte count of >/=750 cell/mm3 or >/=500 is >20kg
  • creatinine clearance or radioisotope GFR >/= 70mL/min/1.73m2 OR normal serum creatinine based on age/gender
  • total bilirubin </= 1.5x upper limit normal OR direct bilirubin </= 1.5mg/dl
  • ALT </= 3x upper limit normal
  • corrected QTc <450msec of ECG
  • Shortening Fraction >28% by ECHO or Ejection Fraction >50% by MUGA
  • Documented negative HIV, Hep B and Hep C
  • Agree to long-term follow up for up to 15 years if they receive T cell infusion

Exclusion Criteria:

  • Philadelphia Positive Leukemia
  • Prior Allogeneic Stem Cell Transplant
  • CNS 2 or 3
  • prior cellular immunotherapy with chimeric antigen receptor modified T cells
  • fully humanized antibodies within three half lives
  • systemic corticosteroids within 7 days of enrollment
  • requires supplemental oxygen or has a chest X-ray with an infectious process
  • CNS pathology (seizure disorder, paresis, aphasia, cerebrovascular ischemia/hemorrhage, severe brain injuries, dementia, cerebellar disease, organic brain syndrome, psychosis, coordination or movement disorder)
  • Pregnant or breastfeeding women. Female participant of reproductive age must have a negative pregnancy test and agree to contraception for 1 year after T cell infusion.
  • Active Malignancy other than CD19+ Leukemia
  • Active severe infection defined as a positive blood culture within 48 hours of study enrollment or a fever >38.2C AND clinical signs of infection within 48 hours of study enrollment
  • Patient has a concurrent medical condition, that in the opinion of the protocol PI or designee, would prevent the patient from undergoing protocol-based therapy.
  • Trisomy 21
  • Primary immunodeficiency/bone marrow failure syndrome
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01683279

Contacts
Contact: Rebecca Gardner, MD 206-884-1087 rebecca.gardner@seattlechildrens.org
Contact: Dione Froman, BS 206-884-1214 dione.froman@seattlechildrens.org

Locations
United States, Washington
Seattle Children's Hospital Recruiting
Seattle, Washington, United States, 98105
Sponsors and Collaborators
Seattle Children's Hospital
Investigators
Principal Investigator: Rebecca Gardner, MD Seattle Children's Hospital
  More Information

No publications provided

Responsible Party: Rebecca Gardner, Acting Assistant Professor, Seattle Children's Hospital
ClinicalTrials.gov Identifier: NCT01683279     History of Changes
Other Study ID Numbers: PLAT-01
Study First Received: September 7, 2012
Last Updated: May 13, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Seattle Children's Hospital:
pediatric
acute lymphoblastic leukemia
CD19
Chimeric Antigen Receptor

Additional relevant MeSH terms:
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Leukemia
Leukemia, B-Cell
Leukemia, Lymphocytic, Chronic, B-Cell
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases

ClinicalTrials.gov processed this record on September 18, 2014