Diffuse Large-Cell Lymphoma, Follicular Lymphoma, High-grade B-cell Lymphoma (HGBCL), Primary Mediastinal Large B-Cell Lymphoma (PMBCL), Transformed Follicular Lymphoma (TFL)
Conditions
Brief summary
The purpose of the study is to evaluate whether receiving the pneumococcal 13-valent conjugate vaccine (PCV13) before and after CD19-targeted CAR T cell therapy will optimize cellular and humoral immunity to pneumococcus.
Detailed description
This is a phase II, single-institution study to investigate if pneumococcal vaccination before and after CD19-targeted CAR T cell therapy elicits cellular and humoral immunity to pneumococcus in patients with relapsed or refractory B cell lymphomas. All the participants will receive the same treatment. Immunoglobulins (IgG) against pneumococcal serotypes not included in the vaccine will be served as an internal control. Treatment includes the same dose (0.5ml) of PCV13 one time prior to apheresis followed by two times after CAR T cell therapy
Interventions
BIOLOGICALPneumococcal conjugate vaccine (PCV13)
Licensed heptavalent pneumococcal conjugate vaccine (PCV13, Pneumococcal 13-valent conjugate vaccine
BIOLOGICALCD19 targeted CAR T Cell Therapy
This is a personalized therapeutic approach that entails removal of T cells from patient's peripheral blood, genetic modification, activation and expansion in vitro to retarget cells against CD19 protein on the surface of B cells, and infusion of the genetically engineered cells back into the patient. CD19 is a surface protein that is expressed on B cells starting from early pre-B cells to mature fully differentiated B cells. Therefore, CD19-targeted CAR T cell therapy can effectively treat refractory B cell lymphomas.
Sponsors
H. Lee Moffitt Cancer Center and Research Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* In good health as evidenced by medical history or diagnosed with relapsed or chemotherapy-refractory diffuse large B cell lymphoma (DLBCL), primary mediastinal B cell lymphoma (PMLBCL), transformed follicular lymphoma (TFL) high-grade B cell lymphoma (HGBCL) or Follicular Lymphoma. Patients must be under consideration for treatment with any CD19-targeted CAR T cell therapy, per institutional standards. Patients undergoing active vital organ testing with a planned apheresis date for CAR T cell therapy may be considered eligible. * Signed informed consent form in accordance with institutional and federal law policies * Stated willingness to comply with all study procedures and availability for the duration of the study * Male or female, age over 18 * For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation
Exclusion criteria
* Pregnant or lactating woman, as evaluated by serum testing within 2 weeks of administration of the first vaccine. Only women of childbearing potential will undergo serum/urine pregnancy testing. A woman will be considered of childbearing potential unless she is status-post hysterectomy or tubal ligation or without menstrual periods in the preceding 12 months. * Common variable immunodeficiency or other inherited systemic immunodeficiency syndrome * History of severe allergy (e.g., anaphylaxis) to any component of pneumococcal conjugate vaccine 7 valent (PCV7), PCV13, or any diphtheria-toxoid containing vaccine. * Inclusion on a separate trial in which patients may be randomized or otherwise started on maintenance chemotherapies within the first 3 months of CD19-targeted CAR T cell therapy * Patients with significant psychiatric illness likely to affect compliance, as determined by the treating physician * Active or uncontrolled infections * Platelet count \<10,000 cells/microliter * Lymphocyte count \<200 cells/microliter * Intervenous immunoglobulin (IVIG) administration within one month of planned apheresis for collection for CD19-targeted CAR T cell manufacture * History of PCV13 administration within one month of planned apheresis for collection for CD19-targeted CAR T cell manufacture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Humoral Response Rate -PCV13 vaccine | 90 days post CAR T therapy | Humoral sero-protection rate elicited by the PCV13 vaccine intervention as measured on day+90 post CART |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Increase in PCV13 specific serotype IgG levels | 90 days post CAR T therapy | PCV13 specific serotype IgG levels on day +90 post CAR T cell therapy as an absolute and as a change from baseline |
| Increase in On-Specific Serotype IgG levels | 90 days post CAR T therapy | Non-specific serotype IgG levels on day +90 post CAR T cell therapy as an absolute and as a change from baseline |
| Response Rate of CD19-targeted CAR T therapy when combined with PCV13 vaccination | 90 days post CAR T therapy | Percentage of patients whose cancer shrinks or disappears after treatment |
| Progression Free Survival | at 90 days and 180 days post CAR T therapy | Progression Free Survival (PFS) from start of treatment to death of any cause, disease progression or relapse of the date of last follow-up, whichever comes first. |
| Overall Survival | 180 days post CAR T therapy | Overall Survival (OS):The length of time from the start of treatment until death by any cause |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORFrederick Locke, MD
Moffitt Cancer Center
Outcome results
None listed