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Immunotherapy Using CAR T-cells to Target CD19 for Relapsed/Refractory CD19+ Primary CNS Lymphoma (CAROUSEL)

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ClinicalTrials.gov Identifier: NCT04443829
Recruitment Status : Recruiting
First Posted : June 23, 2020
Last Update Posted : June 14, 2022
Sponsor:
Information provided by (Responsible Party):
University College, London

Brief Summary:

The CAROUSEL Trial is a single-centre, non-randomised, open label Phase I clinical trial of an Advanced Therapy Investigational Medicinal Product (ATIMP) in adults (age ≥16) with relapsed/refractory Primary CNS Lymphoma.

The study will evaluate the feasibility of generating the ATIMP, the safety of administering CD19CAR T-cell therapy and how effectively CD19CAR T-cells engraft, expand and persist following administration in patients with relapsed/refractory primary CNS lymphoma.


Condition or disease Intervention/treatment Phase
Primary CNS Lymphoma Biological: CD19CAR T-cells Phase 1

Detailed Description:

The CAROUSEL Trial is a single-centre, non-randomised, open label Phase I clinical trial of an Advanced Therapy Investigational Medicinal Product (ATIMP) in adults (age ≥16) with relapsed/refractory Primary CNS Lymphoma. The ATIMP for this study is cryopreserved autologous patient-derived T-cells transduced with CD19CAR vector to generate CD19CAR T-cells.

Patients will undergo an unstimulated leucapheresis for the generation of the ATIMP which will take approximately 15 days to generate. During this period, patients may receive "holding" chemotherapy as per institutional practice to maintain disease control. Patients will receive pre-conditioning lymphodepleting (LD) chemotherapy with cyclophosphamide 60mg/kg on Day -6, fludarabine 30mg/m2 administered over 3 days (Day -5 to Day -3) and pembrolizumab 200mg on Day -1.

All patients will be treated on Theme 1 of the study with 250 x 10^6 CD19 CAR T-cells i.v. following LD chemotherapy as described above. Patients with response of Stable Disease (SD) or Progressive Disease (PD) at Day 28 (or frank relapse beyond Day 28) and in the absence of severe toxicity related to the ATIMP, will be potentially eligible for Theme 2 of the study where they can receive Dose 2, a single dose of 25 x 10^6 CD19CAR T-cells intraventricularly via an Ommaya reservoir following LD chemotherapy as described above.

The study will evaluate the feasibility of generating the ATIMP, the safety of administering CD19CAR T-cell therapy and how effectively CD19CAR T-cells engraft, expand and persist following administration in patients with relapsed/refractory primary CNS lymphoma.

Following infusion of CD19CAR T-cell therapy patients will be monitored for between 2-4 weeks as an inpatient. Following discharge, patients will enter the interventional follow up phase and be followed up for 2 years. Patients will be seen monthly for the first 6 months, then 6 weekly to 12 months and then 3 monthly until 2 years post CD19CAR T-cell infusion.

If patients relapse within the first 2 years post CD19CAR T-cell infusion they will come off the interventional follow up and will be followed up annually until the end of trial is declared.

After completing the interventional phase of the study all patients, irrespective of whether they progressed or responded to treatment, will enter long term follow up until the end of trial is declared.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 12 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Immunotherapy Using CAR T-cells to Target CD19 for Relapsed/Refractory CD19+ Primary Central Nervous System (CNS) Lymphoma
Actual Study Start Date : March 23, 2021
Estimated Primary Completion Date : December 2024
Estimated Study Completion Date : December 2032

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Lymphoma

Arm Intervention/treatment
Experimental: CD19CAR T-cells
Treatment with the ATIMP: CD19CAR T-cells
Biological: CD19CAR T-cells
Infusion with: CD19CAR T-cells




Primary Outcome Measures :
  1. Toxicity evaluated by the incidence of grade 3-5 toxicity causally related to the ATIMP [ Time Frame: 28 days ]
    Toxicity following CD19CAR T-cell administration as evaluated by the incidence of grade 3-5 toxicity causally related to the ATIMP

  2. Feasibility of manufacturing CD19CAR T-cells evaluated by the number of therapeutic products generated [ Time Frame: 28 days ]
    Feasibility of adequate leucapheresis collection and generation of CD19CAR T-cells as evaluated by the number of therapeutic products generated.


Secondary Outcome Measures :
  1. Response at 1 and 3 months [ Time Frame: From CD19CAR T-cells infusion to 1 and 3 months ]
    Proportion of patients achieving a Complete Response (CR) or Partial Response (PR) at 1 and 3 months post CD19CAR T-cells infusion: Theme 1 (i.v.) and Theme 2 (intraventricular)

  2. Frequency of circulating CD19CAR T-cells in peripheral blood [ Time Frame: From CD19CAR T-cells infusion up to 2 years post CD19CAR T-cells infusion ]
    Frequency of circulating CD19CAR T-cells in peripheral blood as assessed by flow cytometry and qPCR

  3. Incidence of B-cell aplasia [ Time Frame: From CD19CAR T-cells infusion up to 2 years post CD19CAR T-cells infusion ]
    Incidence of B-cell aplasia

  4. Relapse rate at 1 and 2 years [ Time Frame: At 1 year and 2 years after CD19CAR T-cells infusion ]
    Proportion of patients who have relapsed at 1 and 2 years after CD19CAR T-cells infusion

  5. Progression Free Survival (PFS) at 1 and 2 years [ Time Frame: At 1 year and 2 years after CD19CAR T-cells infusion ]
    Progression Free Survival at 1 and 2 years after CD19CAR T-cells infusion

  6. Overall Survival (OS) at 1 and 2 years [ Time Frame: At 1 year and 2 years after CD19CAR T-cells infusion ]
    Overall Survival at 1 and 2 years after immunotherapy with CD19CAR T-cells infusion



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:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age ≥16
  2. Patients with a histologically confirmed Diffuse Large B-Cell Lymphoma (DLBCL) confined to the CNS (Primary CNS Lymphoma (PCNSL))
  3. Relapsed* or refractory CD19+ PCNSL, defined as disease progression following CR/CRu/PR, or failure to achieve PR, after one or more lines of a high-dose methotrexate-containing protocol *Histological confirmation by re-biopsy at relapse is recommended if feasible. However, patients will be eligible without re-biopsy provided the initial diagnostic material is available and current MRI imaging features are consistent with PCNSL by neuroradiology review.
  4. Measurable disease on contrast-enhanced MRI
  5. Unsuitable for alternative salvage therapies as determined by their treating physician
  6. Agreement to have a pregnancy test, use highly effective contraception (if applicable)
  7. Written informed consent** ** Some patients with PCNSL may be incapable of providing their own consent due to the neurological effects of their disease. In these cases a legal representative may be sought to provide consent'.

Exclusion Criteria (Registration):

  1. CD19 negative disease
  2. Evidence of secondary CNS lymphoma
  3. Prior allogeneic haematopoietic stem cell transplant
  4. Active hepatitis B, C or HIV infection
  5. Oxygen saturation ≤90% on air
  6. Bilirubin >2 x upper limit of normal
  7. Glomerular Filtration Rate (GFR) <50ml/min
  8. Women who are pregnant or breast feeding
  9. Inability to tolerate leucapheresis
  10. ECOG 3-4
  11. Known allergy to albumin or Dimethyl sulfoxide (DMSO)
  12. Life expectancy <3months
  13. Arrhythmias or significant cardiac disease and left ventricular ejection fraction <40%
  14. Pre-existing neurological disorders (other than CNS involvement of underlying haematological malignancy)
  15. Any contraindications to PD-1 antibody Pembrolizumab
  16. History of autoimmune disease (e.g. Crohn's, rheumatoid arthritis, systemic lupus) resulting in end organ injury or requiring systemic immunosuppression/systemic disease modifying agents within the last 24 months
  17. Evidence of active pneumonitis on chest computed tomography (CT) or positron emission tomography (PET)-CT scan at screening or history of drug-induced pneumonitis, idiopathic pulmonary fibrosis, organising pneumonia (e.g. bronchiolitis obliterans), or idiopathic pneumonitis. Prior radiation pneumonitis in the radiation field (fibrosis) is allowed (if >24 weeks since the event)

Exclusion criteria: for CD19CAR T-cell infusion ( Dose 1/i.v. and Dose 2/intraventricular):

  1. Severe intercurrent infection at the time of scheduled CD19CAR T-cell infusion
  2. Requirement for supplementary oxygen or active pulmonary infiltrates at the time of scheduled CD19CAR T-cell infusion
  3. Theme 2 only:

    1. presence of grade 3 or 4 ICANS casually related to the ATIMP following infusion of Dose 1
    2. grade 1-2 neurotoxicity (if occurred) following Theme 1 dosing (Dose 1/i.v CD19CAR Tcell dose) that has not fully resolved prior to proposed administration of 2nd CD19CAR T-cell infusion (Dose /intraventricular) for theme 2
    3. grade 3-4 CRS following infusion of Dose 1
    4. persisting grade 2 CRS following Theme 1 dosing (Dose 1/i.v CD19CAR T-cell dose) that has not resolved to ≤ grade 1 CRS prior to proposed administration of 2nd CD19CAR Tcell infusion (Dose 2/intraventricular) for theme 2
    5. pregnancy

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): NCT04443829


Contacts
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Contact: CAROUSEL Trial Coordinator 02076799860 ctc.carousel@ucl.ac.uk

Locations
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United Kingdom
University College London Hospital Recruiting
London, United Kingdom, WC1E6BT
Contact: Claire Roddie         
Sponsors and Collaborators
University College, London
Investigators
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Study Chair: Claire Roddie University College London Hospital
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Responsible Party: University College, London
ClinicalTrials.gov Identifier: NCT04443829    
Other Study ID Numbers: UCL/126892
First Posted: June 23, 2020    Key Record Dates
Last Update Posted: June 14, 2022
Last Verified: June 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Lymphoma
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases