Acute Myeloid Leukemia, Recurrent Adult Acute Myeloid Leukemia, Refractory Acute Myeloid Leukemia, Secondary Acute Myeloid Leukemia
Conditions
Brief summary
This phase I trial tests the safety, side effects, and the best dose of anti-CD33 chimeric antigen receptor (CAR) T-Cell therapy in treating patients with acute myeloid leukemia that has come back (recurrent) or does not respond to treatment (refractory). CAR T-cell therapy is a type of treatment in which a patient or donor's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells. T cells are taken from a patient's or donor's blood. Then the gene for a special receptor that binds to a certain protein on the patient's cancer cells is added to the T cells in the laboratory. The special receptor is called a chimeric antigen receptor. Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion for treatment of certain cancers.
Detailed description
PRIMARY OBJECTIVE: I. Examine the anti-tumor activity and safety of administering patient-specific donor-derived (allogeneic) CD33-CAR T cells following lymphodepletion in research participants with CD33+ recurrent/refractory (r/r) acute myeloid leukemia (AML). SECONDARY OBJECTIVE: I. Assess activity in the form of CAR T cell expansion and persistence, to assess impact on hematopoiesis, 6-month progression free survival (PFS 6mo) rate, duration of response, and 1-year overall survival (OS) rate. EXPLORATORY OBJECTIVES: I. Change from baseline in numbers of CD33+ blood cells, CD33 expression on leukemia cells and hematopoietic cells. II. For subjects who receive cetuximab for CAR T cell ablation, assess the activity of infusional cetuximab to eliminate transferred CD33R(CD8h)BBzeta/EGFRt+ T cells. OUTLINE: This is a dose-escalation study. Patients undergo lymphodepletion therapy 3-5 days prior to CAR T cell infusion and receive anti-CD33 CAR T-cells intravenously (IV) on day 0. Patients with persistent CD33+ AML who are \> 28 days past the initial CAR T infusion, have additional product available and did not experience a dose-limiting toxicity, may optionally receive anti-CD33 CAR T-cells IV.
Interventions
BIOLOGICALAnti-CD33 CAR T-cells
Given IV
PROCEDURELymphodepletion Therapy
Undergo lymphodepletion
Sponsors
City of Hope Medical Center
National Cancer Institute (NCI)
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
* Documented informed consent of the participant and/or legally authorized representative * Assent, when appropriate, will be obtained per institutional guidelines * For research participants who do not speak English, a short form consent may be used with a City of Hope (COH) certified interpreter/translator to proceed with screening, while the request for a translated full consent is processed * Agreement to allow the use of archival tissue from diagnostic tumor biopsies * If unavailable, exceptions may be granted with Study principal investigator (PI) approval * Age: \>= 18 years * Karnofsky Performance Scale (KPS) \>= 70 * Life expectancy \>= 16 weeks at the time of enrollment * Prior allogeneic transplant allowed if \> 6 months prior to study enrollment * Participant must have a confirmed diagnosis of active CD33+ AML de novo, or secondary OR participants who are at a high risk for disease recurrence * Relapsed AML is defined as patients that had a first complete response (CR) before developing recurrent disease (increased bone marrow blasts) * Refractory AML is defined as patients that have not achieved a first CR after induction chemotherapy. For patients with AML evolving from myelodysplastic syndrome, they should have completed at least one cycle of induction chemotherapy * Research participants must have bone marrow and/or peripheral blood samples available for confirmation of diagnosis of AML * CD33 positivity must be confirmed by either flow cytometry or immunohistochemistry within 90 days of study entry. Cytogenetics, flow cytometry, and molecular studies (such as FLT-3 status) will be obtained as per standard practice * Research participants who are at a high risk of disease recurrence, they must have historical bone marrow and/or peripheral blood samples available for confirmation of diagnosis of AML * No known contraindications to lymphodepleting agents, steroids, tocilizumab and/or cetuximab, or the investigational agent * Total serum bilirubin =\< 2.0 mg/dL * Participants with Gilbert syndrome may be included if their total bilirubin is =\< 3.0 * Aspartate aminotransferase (AST) =\< 3 x the upper limit of normal (ULN) * Alanine aminotransferase (ALT) =\< 3 x ULN * Estimated creatinine clearance of \>= 60 mL/min per the Cockcroft-Gault formula, and the participant is not on hemodialysis * Left ventricular ejection fraction \>= 50% within 8 weeks before enrollment * Oxygen (O2) saturation \> 92% not requiring oxygen supplementation * Women of childbearing potential (WOCBP): negative urine or serum pregnancy test * If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required * Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 6 months after the last dose of protocol therapy * Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for \> 1 year (women only) * Research participants must have a potential donor or stem cell source identified for allogeneic transplantation, either related (7/8 or 8/8 allele matched or haploidentical) * DONOR: The identified donor must be the original donor whose stem cells were used for the research participant's allogeneic hematopoietic stem cell transplantation (alloSCT) * DONOR: The donor must be HIV negative * DONOR: KPS \>= 70 * DONOR: Documented body weight
Exclusion criteria
* Prior allogeneic transplant if \< 6 months prior to enrollment * Concurrent use of systemic steroids or chronic use of immunosuppressant medications should be stopped 28-days prior to enrollment. Recent or current use of inhaled or topical steroids in standard doses is not exclusionary. Physiologic replacement of steroids (prednisone =\< 7.5 mg/day, or equivalent doses of other corticosteroids) is allowed * Participants with active autoimmune disease, including graft versus host disease (GvHD), requiring systemic immune suppressive should be stopped 28-days prior to enrollment * Participants may not be receiving any other investigational agents and are not dependent on concurrent biological therapy, chemotherapy, or radiation therapy * With exception to Hydrea which must be stopped prior to initiation of lymphodepletion * Research participants on active systemic antifungal treatment within 8 weeks of enrollment are not eligible. However, participants on antifungal prophylaxis are eligible * Not applicable at the time of enrollment if the research participant's donor is undergoing leukapheresis * Subjects with \>= Grade 2 myelofibrosis on bone marrow biopsy * Subjects with clinically significant arrhythmia or arrhythmias not stable on medical management within two weeks of screening if the patient is undergoing leukapheresis. Patients with controlled atrial arrythmia is allowed * Known bleeding disorders (e.g., von Willebrand's disease) or hemophilia * History of stroke or intracranial hemorrhage within 6 months prior to screening * Subjects with presence of other active malignancy, however, research participants with history of prior malignancy treated with curative intent and in complete remission are eligible * Clinically significant uncontrolled illness * Active infection requiring antibiotics * Research participants who have tested human immunodeficiency virus (HIV) positive, or have active hepatitis B or C infection based on testing performed within 4 weeks of enrollment * Active viral hepatitis * Females only: Pregnant or breastfeeding * Any other condition that would, in the Investigator's judgment, contraindicate the subject's participation in the clinical study due to safety concerns with clinical study procedures * Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participants who achieve measurable residual disease (MRD) | Up to 15 years post study treatment | Defined as complete response (CR) or MRD- complete response with incomplete hematopoietic recovery. Rates and associated 90% Clopper and Pearson binomial confidence limits. |
| Incidence of dose-limiting toxicities and full toxicity profile | Up to 1 year following the last CAR T cell infusion | Rates and associated 90% toxicity and adverse events will be assessed using Common Terminology Criteria for Adverse Events version 5.0, and modified Cytokine Release Syndrome grading as applicable. Clopper and Pearson binomial confidence limits. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Expansion and persistence of the CAR T cell product | Up to 15 years post-CAR T cell infusion | Descriptive statistics and graphical methods will be used to present expansion and persistence. |
| Percent and counts from peripheral blood cell subsets in hematopoietic stem/progenitor cell compartments | Up to 15 years post-CAR T cell infusion | Descriptive statistics and graphical methods will be used to present T cell numbers and percentages over time. |
| Duration of response | From the first achievement of CR after CAR T cell infusion through disease relapse or progression or death, assessed up to 15 years post CAR T cell infusion | Patients who have not had disease relapse/progression or death at the last follow-up will be censored at the time of last follow-up. Patients who never achieved CR will be excluded from the analysis. Descriptive statistics will be provided for duration of response. |
| Progression-free survival | From the start of treatment to the date of death, disease relapse, or last follow-up whichever occurs first, assessed up to 15 years post CAR T cell infusion | Participants are considered a failure for this endpoint if they die (regardless of cause) or experience disease relapse. |
| Overall survival | from start of protocol therapy to death, or last follow-up, whichever comes first, assessed up to 15 years post CAR T cell infusion | Participants are considered a failure for this endpoint if they die, regardless of cause. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKaramjeet S Sandhu
City of Hope Medical Center
Outcome results
None listed