UCD19 CarT in Treatment of Pediatric B-ALL and B-NHL
Phase I/II Dose Escalation and Preliminary Efficacy of CD19 Directed CAR-T Cells Generated Using the Miltenyi CliniMACs Prodigy System (UCD19 CAR-T) in Pediatric Patients With Relapsed and/or Refractory B-Cell Acute Lymphoblastic Leukemia (B-ALL) and B-Cell Non-Hodgkin Lymphoma (B-NHL)
University of Colorado, Denver
45 participants
Mar 10, 2021
INTERVENTIONAL
Conditions
Summary
This phase I/II trial will investigate a new CD19 directed CAR-T therapy manufactured locally with the goals to expedite infusion to wider patient inclusion that includes those who were previously excluded, such as pediatric patients with B-cell NHL and patients in primary relapse.
Eligibility
Inclusion Criteria34
- Meets clinical criteria for leukapheresis or has a leukapheresis product previously collected and stored per recommended guidelines.
- Provision of signed and dated consent form from parent or guardian (patients \<18), the patient themselves (\>18), or legally authorized representative (patient \>18 who lack decision-making capacity); Pediatric patients will be included in age-appropriate discussions and assent will be obtained for those \> 7 years of age, when appropriate, according to institutional standards.
- Willingness to participate in long term follow up study.
- Stated willingness to comply with all study procedures and be available for the duration of the study.
- Males OR non-pregnant, non-breastfeeding females.
- o Patients of child-bearing potential or capable of fathering a child must agree to use highly effective contraception from the time of initial CAR T cell administration though 12 months following the final administration of investigational product.
- Aged 31 days to 30 years (inclusive) at time of consent and enrollment.
- Acute Lymphoblastic Leukemia (ALL) OR Non-Hodgkin Lymphoma (NHL) of B-cell origin that:
- o Has confirmed expression of CD19 by flow cytometry, immunohistochemistry (IHC), or both.
- Cohort One Criteria:
- Meets any one of the following conditions:
- Relapsed two or more times
- Relapsed at any time after allogeneic BMT
- Refractory to standard therapy as determined by the treating physician
- Meets criteria for BMT but is ineligible as determined by the treating physician
- Patient and/or parents declining BMT options and would prefer CAR-T Therapy.
- Non-Hodgkin Lymphoma includes all of the following:
- Diffuse large B-cell lymphoma (DLBCL)
- Burkitt Lymphoma
- Intermediate lymphoma between Burkitt and DLBCL
- Primary Mediastinal B-cell Lymphoma (PMBL)
- Follicular lymphoma
- High grade B cell lymphoma
- Transformed lymphoma
- Cohort Two Criteria:
- B-ALL in first relapse with any one of the following conditions:
- High-risk genomic alterations at initial diagnosis such as KMT2A gene rearrangement, t(17;19), hypodiploidy, Ph-like mutations, BCR-ABL1 fusion (Ph+ ALL), iAMP21, and TP53 inactivating mutation/deletion.
- Isolated CNS relapse such that cranial radiation would be indicated as a component of standard salvage therapy.
- Down syndrome.
- Minimal residual disease (MRD) positivity of \> 0.01% by FACS or \> 0 clonal sequences by NGS in bone marrow post re-induction chemotherapy.
- Age 18 years or older. OR
- Newly diagnosed with persistent MRD ≥ 0.01% by flow cytometry in bone marrow at end of consolidation.
- Performance score (Lansky or Karnofsky) of 50% or better;
- Unable to or declined to receive commercially available CD19 CAR-T Therapy.
Exclusion Criteria11
- Evidence of rapidly progressive disease without adequate salvage/bridging regimens as determined by the investigator.
- Active Graft-versus-Host Disease (GvHD).
- Active, uncontrolled, life-threatening infection that at the determination of the treating physician would preclude safe leukapheresis or tolerance of LD chemotherapy, cell infusion, or cytokine release syndrome.
- Evidence of severe organ dysfunction as defined by:
- Myocardial dysfunction: Ejection fraction ≤ 40% or shortening fraction ≤ 28%, evidence of physiologically significant pericardial effusion as determined by an echocardiogram (ECHO), and clinically significant electrocardiogram (ECG) findings.
- Baseline oxygen saturation of ≤ 90% on room air
- Transaminases \> 10x upper limit of normal (ULN) or bilirubin \>2x the ULN, unless thought to be related to primary disease
- Estimated Cr clearance \<60 mL/min/1.73 m2 (if nuclear medicine GFR or other more specific testing exceeds this level than it can supersede the estimated clearance)
- Post-pubertal females that are pregnant, planning to become pregnant, or unwilling to use birth control (includes abstinence) for the study duration.
- Known HIV infection, or active Hepatitis B or active Hepatitis C infection.
- Prior gene therapy, including prior CAR-T cell.
Interventions
The CD19 CAR used in this study consists of three main components: the variable regions of the anti-CD19 monoclonal antibody FMC63 71, linked to the TNFRSF-19-derived transmembrane domain, the 4-1BB costimulatory molecule, and the signaling domain of the CD3-zeta molecule. The DNA encoding this receptor was cloned into a lentiviral vector (LV) backbone.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT04544592