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Study of the Tocilizumab Optimization Timing for CART19 Associated Cytokine Release Syndrome

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. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02906371
Recruitment Status : Active, not recruiting
First Posted : September 20, 2016
Last Update Posted : November 4, 2019
Sponsor:
Collaborator:
Children's Hospital of Philadelphia
Information provided by (Responsible Party):
University of Pennsylvania

Brief Summary:
This is a two cohort, open-label, pilot study to describe the efficacy of administration timing of tocilizumab on CART19 (CTL019) associated cytokine release syndrome safety events in pediatric patients with CD19 expressing relapsed and refractory B-cell acute lymphoblastic leukemia with high versus low pre-infusion tumor burden following redirected autologous T cells transduced with the anti-CD19 lentiviral vector (CART19/CTL019).

Condition or disease Intervention/treatment Phase
Lymphoblastic Leukemia, Acute, Childhood Drug: Tocilizumab Biological: CART 19 Not Applicable

Detailed Description:

The duration of active protocol intervention is approximately 12-15 months from the screening visit. The protocol will require approximately 12-18 months to complete enrollment.Approximately 39 enrolled patients to reach at least 35 infused patients, with the ultimate goal of 15 patients in the high tumor burden cohort (Cohort A). Inclusion criteria are designed to include pediatric patients aged 1-24 years with CD19 expressing relapsed/refractory B-cell acute lymphoblastic leukemia (ALL).Tocilizumab will be given once to high disease burden patients, and then the patients will be managed for CRS as per the standard algorithm (including subsequent tocilizumab, if needed).

Two cohorts are defined based upon pre-infusion high versus low tumor burden; with the high tumor burden cohort (high risk of severe CRS) to receive earlier administration of tocilizumab for CRS management and the low tumor burden cohort (low risk of severe CRS) to receive standard timing of tocilizumab for CRS

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 80 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Two Cohort Pilot Study of the Tocilizumab Optimization Timing for CART19 Associated Cytokine Release Syndrome (CRS) Management in Pediatric Patients With CD19 Expressing Relapsed/Refractory B-cell Acute Lymphoblastic Leukemia (ALL)
Study Start Date : August 2016
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : June 2021


Arm Intervention/treatment
Active Comparator: Tocilizumab high tumor burden
This is a two cohort, open-label, pilot study to describe the efficacy of administration timing of tocilizumab on CART19 (CTL019) associated CRS safety events in pediatric patients with CD19 expressing relapsed and refractory B-cell acute lymphoblastic leukemia with high pre-infusion tumor burden following redirected autologous T cells transduced with the anti-CD19 lentiviral vector (CART19/CTL019).
Drug: Tocilizumab
Patients with ≥ 40% blasts in the bone marrow at pre-infusion will be enrolled in the early tocilizumab cohort and will follow early CRS treatment algorithm.
Other Name: high tumor burden

Biological: CART 19
CART-19 cells transduced with a lentiviral vector to express either anti-CD19ζ scFv TCRζ:41BB, administered by i.v. injection using an intra-patient dose escalation approach: 10% on day 0, 30% on day 1 with a total dose goal of ~1.5 x107 - 5 x109 (~3x105 - 1x108/kg) T cells.

Active Comparator: Tocilizumab low tumor burden
This is a two cohort, open-label, pilot study to describe the efficacy of administration timing of tocilizumab on CART19 (CTL019) associated CRS safety events in pediatric patients with CD19 expressing relapsed and refractory B-cell acute lymphoblastic leukemia with low pre-infusion tumor burden following redirected autologous T cells transduced with the anti-CD19 lentiviral vector (CART19/CTL019).
Drug: Tocilizumab
Patients with ˂ 40% blasts in the bone marrow at pre-infusion (~ Day -5 to -1) will follow the standard CRS Rx algorithm
Other Name: low tumor burden

Biological: CART 19
CART-19 cells transduced with a lentiviral vector to express either anti-CD19ζ scFv TCRζ:41BB, administered by i.v. injection using an intra-patient dose escalation approach: 10% on day 0, 30% on day 1 with a total dose goal of ~1.5 x107 - 5 x109 (~3x105 - 1x108/kg) T cells.




Primary Outcome Measures :
  1. the frequency of grade 4 CRS [ Time Frame: from day 1 to 1 year ]
    Frequency of CRS grade 4


Secondary Outcome Measures :
  1. tumor response [ Time Frame: day 28 ]
    Frequency of CR with minimal residual disease negative bone marrow at day 28 and duration of remission


Other Outcome Measures:
  1. CART19 cellular kinetics [ Time Frame: from day -1 to year 1 ]
    Peak plasma concentration (Cmax) of CART19 cellular kinetic

  2. Number of days in ICU [ Time Frame: from day 0 through year one. ]
  3. Frequency of major medical interventions [ Time Frame: from day 0 through year one. ]
  4. CART19 cellular kinetics [ Time Frame: from day -1 through year 1 ]
    Area under the plasma concentration versus time curve (AUC)



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:   1 Year to 24 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Signed informed consent form must be obtained prior to any study procedure. Labs, marrows or other procedures obtained during routine clinical care may be used for eligibility if obtained within the protocol required windows.
  2. Relapsed or refractory B-cell ALL/lymphoblastic lymphoma:

    1. 2nd or greater relapse (marrow or CNS) OR
    2. Any relapse after allogeneic hematopoietic stem cell (SCT) transplant and ≥ 6 months from stem cell transplantation at infusion OR
    3. Any relapse after CAR-modified T cell therapy OR
    4. Refractory disease defined as having not achieved an MRD-negative CR after > 2 chemotherapy regimens/cycles (1 cycle for relapsed patients) OR
    5. Patients with Ph+ ALL are eligible if they are intolerant to or have failed tyrosine kinase inhibitor therapy OR
    6. Ineligible for allogeneic SCT because of:

      • Comorbid disease
      • Other contraindications to allogeneic SCT conditioning regimen
      • Lack of suitable donor
      • Prior SCT
      • Declines allogeneic SCT as the therapeutic option after documented discussion, with expected outcomes, about the role of SCT with a bone marrow transplant (BMT) physician not part of the study team
    7. Patients with CNS3 disease will be eligible if CNS disease is responsive to therapy (at infusion, must meet criteria in Section 5.3)
  3. Documentation of CD19 tumor expression in bone marrow or peripheral blood by flow cytometry at relapse (or a recent marrow in the case of refractory disease). If the patient has received CD19-directed therapy (i.e. blinatumomab), then the marrow should be obtained after this therapy to show CD19 expression.
  4. Adequate organ function defined as:

    1. A serum creatinine based on age/gender as follows:

      Maximum Serum Creatinine (mg/dL)

      Age Male Female

      • 1 to < 2 years 0.6 0.6
      • 2 to < 6 years 0.8 0.8
      • 6 to < 10 years 1.0 1.0
      • 10 to < 13 years 1.2 1.2
      • 13 to < 16 years 1.5 1.4
      • ≥ 16 years 1.7 1.4
    2. ALT< 500 U/L
    3. Bilirubin <2.0 mg/dl
    4. Must have a minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea, pulse oximetry > 92% on room air; DLCO > 40% (corrected for anemia) if PFTs are clinically appropriate as determined by the treating investigator
    5. Left Ventricular Shortening Fraction (LVSF) ≥ 28% or Ejection Fraction (LVEF) ≥ 40% confirmed by ECHO, or adequate ventricular function documented by a scan or a cardiologist.
  5. Evidence of disease by standard morphologic or MRD criteria. A clinical marrow showing disease may be performed at enrollment or within 12 weeks of enrollment.
  6. Age 1-24 years.
  7. Adequate performance status (Lansky or Karnofsky score ≥50).
  8. Subjects of reproductive potential must agree to use acceptable birth control methods, as described in protocol Section 4.3.

Exclusion Criteria:

  1. Active hepatitis B or active hepatitis C.
  2. HIV Infection.
  3. Active acute or chronic graft-versus-host disease (GVHD) requiring systemic therapy.
  4. Concurrent use of systemic steroids or immunosuppressant medications. Recent or current use of inhaled steroids or physiologic replacement with hydrocortisone is not exclusionary. For additional details regarding the use of steroids and immunosuppressant medication, please see Section 5.6.
  5. CNS3 disease that is progressive on therapy, or with CNS parenchymal lesions that might increase the risk of CNS toxicity.
  6. Pregnant or nursing (lactating) women.
  7. Receipt of a prior investigational study agent within 4 weeks prior to screening visit.

    • Note- patients who have received anti-CD19 CART cells on a study where cell infusion occurred greater than 4 weeks before the screening visit are NOT excluded.

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): NCT02906371


Locations
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United States, Pennsylvania
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
University of Pennsylvania
Children's Hospital of Philadelphia
Investigators
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Principal Investigator: Stephan A Grupp, MD,PhD Children's Hospital of Philadelphia

Additional Information:
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Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT02906371    
Other Study ID Numbers: 16CT022, 825445
First Posted: September 20, 2016    Key Record Dates
Last Update Posted: November 4, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Additional relevant MeSH terms:
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Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases