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CD19-Specific T Cells Post AlloSCT

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03579888
Recruitment Status : Recruiting
First Posted : July 9, 2018
Last Update Posted : July 24, 2020
Sponsor:
Collaborator:
Ziopharm Oncology
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
This phase I trial investigates the side effects and best dose of CD19 positive (+) specific CAR-T cells in treating patients with CD19+ lymphoid malignancies, such as acute lymphoblastic leukemia, non-Hodgkin lymphoma, small lymphocytic lymphoma, or chronic lymphocytic lymphoma. Sometimes researchers change the genetic material in the cells of a patient's T cells using a process called gene transfer. Researchers then inject the changed T-cells into the patient's body. Receiving the T-cell infusion may help to control the disease.

Condition or disease Intervention/treatment Phase
B Acute Lymphoblastic Leukemia With t(v;11q23.3); KMT2A Rearranged Recurrent B Acute Lymphoblastic Leukemia Recurrent Chronic Lymphocytic Leukemia Recurrent Diffuse Large B-Cell Lymphoma, Not Otherwise Specified Recurrent Mantle Cell Lymphoma Recurrent Non-Hodgkin Lymphoma Recurrent Ph-Like Acute Lymphoblastic Leukemia Recurrent Primary Mediastinal (Thymic) Large B-Cell Cell Lymphoma Recurrent Small Lymphocytic Lymphoma Refractory B Acute Lymphoblastic Leukemia Refractory Chronic Lymphocytic Leukemia Refractory Diffuse Large B-Cell Lymphoma, Not Otherwise Specified Refractory Mantle Cell Lymphoma Refractory Non-Hodgkin Lymphoma Refractory Ph-Like Acute Lymphoblastic Leukemia Refractory Primary Mediastinal (Thymic) Large B-Cell Cell Lymphoma Refractory Small Lymphocytic Lymphoma Biological: Autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-HER1t T Cells Drug: Cyclophosphamide Drug: Fludarabine Phase 1

Detailed Description:

PRIMARY OBJECTIVE:

I. To determine the safety and maximum tolerated dose (MTD) of donor-derived genetically modified, CD19-specific T cells expressing mbIL15 and HER1t using the Rapid Personalized Manufacture (RPM) process (autologous CD19-CD8-CD28-CD3zeta-chimeric antigen receptor [CAR]-mbIL15-HER1t T cells [CD19-mbIL15-CAR-T cells]) administered to patients with CD19+ advanced lymphoid malignancies who have previously received an allogeneic hematopoietic stem cell transplantation (HSCT), including haploidentical HSCT.

SECONDARY OBJECTIVES:

I. To demonstrate the feasibility of the RPM process. II. To determine the incidence and grading of cytokine release syndrome (CRS) and neurotoxicity.

III. To determine persistence of genetically modified T cells. IV. To determine if cetuximab can control numbers of infused T cells. V. To screen for the development of host immune responses against the transgenes (one or more of CAR, mbIL15, HER1t).

VI. To determine cytokine profile of the patient with infused T cells. VII. To demonstrate the homing ability of the infused T cells. VIII. To assess disease response after T-cell infusion. IX. To assess progression-free and overall survival. X. To detect emergence of CD19 negative (neg) malignant B cells.

OUTLINE: This is a dose-escalation study of autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-HER1t T cells.

CHEMOTHERAPY: Patients receive fludarabine intravenously (IV) over 1 hour and cyclophosphamide IV over 3 hours on days -5, -4, and -3 in the absence of disease progression or unacceptable toxicity.

T-CELL INFUSION: Patients receive autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-HER1t T cells IV over 15-30 minutes on day 0.

After completion of study treatment, patients are followed up within 3 days after T-cell infusion and at 1, 2, 3, 4, 6, and 8 weeks, then at 3, 6, and 12 months, then periodically for up to 15 years.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Donor-Derived Very-Rapid Manufactured CD19-Specific T Cells for Lymphoid Malignancies After Allogeneic Hematopoietic Stem-Cell Transplantation
Actual Study Start Date : June 26, 2020
Estimated Primary Completion Date : November 30, 2021
Estimated Study Completion Date : November 30, 2021


Arm Intervention/treatment
Experimental: Treatment (fludarabine, cyclophosphamide, CD19 T cell)

CHEMOTHERAPY: Patients receive fludarabine IV over 1 hour and cyclophosphamide IV over 3 hours on days -5, -4, and -3 in the absence of disease progression or unacceptable toxicity.

T-CELL INFUSION: Patients receive autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-HER1t T cells IV over 15-30 minutes on day 0.

Biological: Autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-HER1t T Cells
Given IV
Other Names:
  • Autologous CD19-CD8-CD28-CD3zeta-CAR-mbIL15-EGFRt T Cells
  • CD19-CD8CD28zCAR-specific-mbIL15-HER1t T-lymphocytes

Drug: Cyclophosphamide
Given IV
Other Names:
  • (-)-Cyclophosphamide
  • 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate
  • Carloxan
  • Ciclofosfamida
  • Ciclofosfamide
  • Cicloxal
  • Clafen
  • Claphene
  • CP monohydrate
  • CTX
  • CYCLO-cell
  • Cycloblastin
  • Cycloblastine
  • Cyclophospham
  • Cyclophosphamid monohydrate
  • Cyclophosphamide Monohydrate
  • Cyclophosphamidum
  • Cyclophosphan
  • Cyclophosphane
  • Cyclophosphanum
  • Cyclostin
  • Cyclostine
  • Cytophosphan
  • Cytophosphane
  • Cytoxan
  • Fosfaseron
  • Genoxal
  • Genuxal
  • Ledoxina
  • Mitoxan
  • Neosar
  • Revimmune
  • Syklofosfamid
  • WR- 138719

Drug: Fludarabine
Given IV
Other Name: Fluradosa




Primary Outcome Measures :
  1. Incidence of adverse events [ Time Frame: Up to 15 years ]
    Graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Adverse events will be summarized by frequencies and percentages by dose level.

  2. Maximum tolerated dose (MTD) as determined by dose limiting toxicity (DLT) [ Time Frame: Up to 30 days post-infusion ]
    The MTD is defined as the highest dose at which no more than 1 of 6 patients experiences a DLT. The study will employ a standard 3+3 design to find the MTD of CD19-specific chimeric antigen receptor (CAR) T cell dose.


Secondary Outcome Measures :
  1. Incidence and grading of cytokine release syndrome (CRS) [ Time Frame: Up to 12 months ]
    Graded according to CTCAE.

  2. Persistence of genetically modified T cells [ Time Frame: Up to 12 months ]
    Persistence of genetically modified T cells will be assessed by the frequency of patients with any detectable CAR-T cells.

  3. Change in numbers of infused T cells [ Time Frame: Up to 12 months ]
    For patients receiving cetuximab (i.e., those who experience >= grade 3 CRS), the change in infused CAR+ T cells from before cetuximab treatment to the nadir of CAR+ T cells after cetuximab summarized by mean, standard deviation, median, and range and days to achieve nadir.

  4. Development of host immune responses against transgenes [ Time Frame: Up to 12 months ]
    The development of host immune responses against the transgenes (one or more of CAR, mbIL15, HER1t) may be assessed by the percentage of patients with antibody formation against each one of the transgenes.

  5. Cytokine levels [ Time Frame: Up to 12 months ]
    Individual patient and aggregate cytokine levels (e.g., IL-15, IL-12, IL-8, etc.) will be summarized by means, standard deviations, medians, and ranges.

  6. Homing ability of the infused T cells [ Time Frame: Up to 12 months ]
    Homing will be assessed based on presence of infused T cells within biopsied tissue. The frequency and percentage of patients experiencing homing and those who have CD19- malignant B cells will be presented.

  7. Disease response [ Time Frame: At days 30 and 100 ]
    Percentage of patients experiencing disease response, defined as partial or complete clearance of disease e.g., by positron emission tomography (PET) and/or bone marrow report will be computed along with a corresponding 95% confidence interval. The percentage of patients who had T cells successfully prepared, released, and infused will be reported. Additional statistical analyses will be performed if deemed appropriate.

  8. Neurotoxicity [ Time Frame: Up to 12 months ]
    Graded according to CTCAE.

  9. Presence of CD19 negative (-) malignant B cells [ Time Frame: Up to 12 months ]
    Presence of CD19- malignant B cells will be based on flow cytometry staining for CD19 in the context of staining for antigens to detect cancerous B cells. The frequency and percentage of patients experiencing homing and those who have CD19- malignant B cells will be presented.

  10. Progression-free survival [ Time Frame: From the time of T-cell infusion to date of progression of date of death, assessed up to 12 months ]
    Will be estimated using the Kaplan-Meier method and presented along with their 95% confidence intervals. Additional statistical analyses will be performed if deemed appropriate.

  11. Overall survival [ Time Frame: From the time of T-cell infusion to date of death, assessed up to 12 months ]
    Will be estimated using the Kaplan-Meier method and presented along with their 95% confidence intervals. Additional statistical analyses will be performed if deemed appropriate.



Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • RECIPIENT: Patients with high risk or relapsed disease who are planning to receive, or have received prior allogeneic HSCT from an human leukocyte antigen (HLA)-matched related, or HLA-mismatched related donor; high risk is defined as patients with acute lymphoblastic leukemia who have delayed clearance of minimal residual disease, Philadelphia (Ph)-like, or complex, 11q23 or hypodiploid karyotype
  • RECIPIENT: Available donor who provided hematopoietic stem-cell (HSC)
  • RECIPIENT: Patients with CD19+ lymphoid malignancies that are refractory to or intolerant of standard treatment (as defined below):

    • B-cell Acute Lymphoblastic Leukemia (ALL)
    • Non-Hodgkin lymphoma (NHL) to include diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B cell lymphoma, mantle cell lymphoma, or transformed follicular lymphoma (TFL) as defined by the World Health Organization 2008 criteria
    • Small lymphocytic lymphoma (SLL)
    • Chronic lymphocytic leukemia (CLL)
    • NOTE: Refractory disease for acute and chronic leukemia is defined by:

      • Presence of > 5% malignant blasts in bone marrow and/or peripheral blood and/or minimal residual disease by flow cytometry or molecular analysis for fusion proteins and/or positive imaging for extra-medullary disease to most recent therapy
    • NOTE: Refractory disease for lymphoma is defined as:

      • Progressive disease or stable disease lasting =< 6 months, as best response to most recent chemotherapy regimen; or disease progression or recurrence =< 12 months after prior ASCT
      • Prior therapy must have included an anti-CD20 monoclonal antibody-containing regimen and an anthracycline-containing chemotherapy regimen
      • For patients with TFL, prior chemotherapy for follicular lymphoma and subsequent refractory disease after transformation to DLBCL
      • At least one measurable lesion according to revised International Working Group (IWG) Response Criteria
  • RECIPIENT: In patients with prior transplant, treatment will begin no earlier than 3 months post-transplant. Enrollment can occur earlier to allow time for donor cell collection
  • RECIPIENT: Karnofsky performance scale > 60
  • RECIPIENT: Patient able to provide written informed consent
  • RECIPIENT: Patient able to provide written informed consent for the long-term follow-up (LTFU) gene therapy study
  • RECIPIENT: Negative human anti-mouse antibody (HAMA)
  • DONOR: HLA-matched related, HLA-mismatched related, including haploidentical donor, or related donor cleared to donate based on Stem Cell Transplantation and Cellular Therapy (SCTCT) standard-of-care (SOC) guidelines
  • DONOR: Negative beta HCG in female of child-bearing potential defined as:

    • Not post-menopausal for 12 months, or
    • No previous surgical sterilization, or
    • Lactating females
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Patient must have measurable disease at the time of treatment
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Not received anti-thymocyte globulin (ATG), Campath, or other T-cell immunosuppressive antibodies or donor-lymphocyte infusion in the 28 days prior to T-cell infusion
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Serum creatinine < 2 x upper limit of normal (ULN)
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) =< 2.5 x ULN or =< 5 x ULN if documented liver metastases
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Total bilirubin =< 1.5 mg/dL, except in patients with Gilbert's syndrome in whom total bilirubin must be =< 3.0 mg/dL
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Cardiac ejection fraction >= 40%, and no clinically-significant electrocardiogram (ECG) findings
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: No clinically significant pleural effusion, baseline oxygen saturation > 90% on room air
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: No evidence of grade >= 2 active graft versus host disease (GVHD) using the Center for International Blood and Marrow Transplant Research (CIBMTR) Acute GVHD Grading System or requiring systemic steroid therapy greater than physiologic dosing at time of starting treatment
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Non-hematologic toxicity grade >= 2 (Common Terminology Criteria for Adverse Events [CTCAE] version 5) related to the lymphodepleting chemotherapy until the toxicity has resolved to grade =< 1 and the patient is afebrile
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: No new grade > 2 neurologic, pulmonary, cardiac, gastrointestinal, renal or hepatic (excluding albumin) toxicity
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Serum creatinine < 2 x ULN
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Oxygen saturation > 90% on room air
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Active clinically significant infection within 7-days of study treatment
  • T-CELL INFUSION REQUIREMENTS FOR RECIPIENT: Using an investigational agent

Exclusion Criteria:

  • RECIPIENT: Positive beta human chorionic gonadotropin (HCG) in female of child-bearing potential defined as not post-menopausal for 12 months or no previous surgical sterilization or lactating females
  • RECIPIENT: Patients with allergy to mouse products or cetuximab
  • RECIPIENT: Active central nervous system (CNS) disease in patient with history of CNS malignancy
  • RECIPIENT: Positive serology for human immunodeficiency virus (HIV)
  • RECIPIENT: Active hepatitis B or active hepatitis C
  • RECIPIENT: Has received a T-cell product within 6 weeks prior to planned infusion of genetically modified T cells

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03579888


Contacts
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Contact: Partow Kebriaei 713-792-8750 pkebriae@mdanderson.org

Locations
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United States, Texas
M D Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Partow Kebriaei    713-792-8750    pkebriae@mdanderson.org   
Principal Investigator: Partow Kebriaei         
Sponsors and Collaborators
M.D. Anderson Cancer Center
Ziopharm Oncology
Investigators
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Principal Investigator: Partow Kebriaei M.D. Anderson Cancer Center
Additional Information:
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Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT03579888    
Other Study ID Numbers: 2019-1063
NCI-2020-03608 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2019-1063 ( Other Identifier: M D Anderson Cancer Center )
P30CA016672 ( U.S. NIH Grant/Contract )
First Posted: July 9, 2018    Key Record Dates
Last Update Posted: July 24, 2020
Last Verified: July 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Lymphoma
Leukemia
Lymphoma, Non-Hodgkin
Leukemia, Lymphoid
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphocytic, Chronic, B-Cell
Lymphoma, B-Cell
Lymphoma, Mantle-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Leukemia, B-Cell
Cyclophosphamide
Fludarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists