Acute Lymphobkastic Leukemia, B Cell Lymphoma
Conditions
Keywords
CD19/22 CAR-T cells, Acute Lymphobkastic Leukemia, B Cell lymphoma, dual targeting CAR-T therapy
Brief summary
The purpose of this study is to estimate the safety and the efficacy of anti-CD19/22 CAR- T cells immunotherapy for adults with relapsed or refractory acute lymphoblastic leukemia/lymphoma.
Detailed description
Locally manufactured second generation autologous CD19/22 CAR-T cells are used for immunotherapy. Protocol treatment includes leukapheresis in order to harvest T cells, lymphodepleting conditioning (fludarabine + cyclophosphamide) followed by one dual targeting CAR-T cells infusion. The Main research objectives of the Phase I: To preliminarily explore the safety (incidence of CRS, ICANS, HLH, infections, late ICAHT, and cytopenias) and tolerability. The Secondary research objectives of the Phase I: To explore the pharmacokinetics of CAR-T cells. The Main research objectives of the Phase II: Overall response rate, including complete response (CR) and partial response (PR) rates. The Secondary research objectives of the Phase II: Duration of response (DOR). Progression-free survival rates. Overall survival rates.
Interventions
BIOLOGICALCD19/22 CAR-T cells
Following preconditioning with chemotherapy (cyclophosphamide and fludarabine) patients will be treated with doses from 50 x 10⁶ to 150 x 10⁶ CD19/CD22 CAR-T cells
Sponsors
Minsk Scientific-Practical Center for Surgery, Transplantation and Hematology
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
1. Male or female, aged ≥18 years. 2. Willing and able to give written, informed consent. 3. Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 1. 4. Relapsed or refractory lymphoblastic leukemia/lymphoma. \- Chemotherapy-refractory disease after ≥1 lines of therapy \- Relapse after chemotherapy or after ASCT/Allo-HSCT. 5. Adequate organ system function including - Creatinine clearance ≥40 cc/min. \- Serum alanine aminotransferase / aspartate aminotransferase ≤2.5 x upper limit of normal (ULN). \- Total bilirubin ≤1.5 x ULN, except in subjects with Gilbert's syndrome. \- Left ventricular ejection fraction (LVEF) ≥50% (by echocardiogram \[ECHO\] or \- Baseline oxygen saturation \>92% on room air and ≤Grade 1 dyspnoea. 6. Have no active GVHD (Grade 2-4) 7. Adequate bone marrow (BM) function - Absolute neutrophil count ≥1.0 × 10\^9/L. * Absolute lymphocyte count ≥0.3 × 10\^9/L (at enrolment and prior to leukapheresis). * Haemoglobin ≥80 g/L. * Platelets ≥75 × 10\^9/L 7\. The expression of CD19 and/or CD22 on the tumor cells are reported as positive by either immunohistochemistry or flow cytometry
Exclusion criteria
1. Females who are pregnant or lactating. 2. History or presence of clinically relevant CNS pathology such as epilepsy, paresis, aphasia, stroke within prior 3 months, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, uncontrolled mental illness, or psychosis. 3. Patients with active CNS involvement by malignancy. Patients with history of central nervous system (CNS) involvement with malignancy may be eligible if CNS disease has been effectively treated and provided treatment was at least 4 weeks prior to enrolment (at least 8 weeks prior to CAR-T infusion). 4. Clinically significant, uncontrolled heart disease or a recent (within 12 months) cardiac event. 5. Active bacterial, viral or fungal infection requiring systemic treatment. Active or latent hepatitis B infection or hepatitis C infection. Testing positive for human immunodeficiency virus, human T cell lymphotropic virus (HTLV1 and 2) or syphilis. 6. History of autoimmune disease resulting in end organ injury or requiring systemic immunosuppression/systemic disease modifying agents within the last 24 months. 6\. Evidence of active pneumonitis on chest computed tomography (CT) scan at screening or history of drug-induced pneumonitis, idiopathic pulmonary fibrosis, organising pneumonia, or idiopathic pneumonitis. 7\. History of other malignant neoplasms unless disease free for at least 24 months (carcinoma in situ, non-melanoma skin cancer, breast or prostate cancer on hormonal therapy allowed). 8\. The following medications are excluded: * Steroids: Therapeutic doses of corticosteroids within 7 days of leukapheresis or 72 hours prior to CAR-T administration. However, physiological replacement, topical, and inhaled steroids are permitted. * Immunosuppression: Immunosuppressive medication must be stopped ≥2 weeks prior to leukapheresis or CAR-T cells infusion. * Cytotoxic chemotherapies within 1 week of CAR-T cellsinfusion and 1 week prior to leukapheresis. * Antibody therapy use including anti-CD20/19/22 therapy within 2 weeks prior to CAR-T cells infusion. * Granulocyte-colony stimulating factor less than 14 days prior to leukapheresis. * Live vaccine ≤4 weeks prior to enrolment. * Prophylactic intrathecal therapy: Methotrexate within 4 weeks and other intrathecal chemotherapy (e.g. Ara-C) within 2 weeks prior to starting pre-conditioning chemotherapy. Prior limited radiation therapy within 2 weeks of CAR-T cells infusion. 9. Known allergy to albumin, dimethyl sulphoxide (DMSO), cyclophosphamide or fludarabine or tocilizumab. 10\. Any other condition that in the Investigator's opinion would make the patient unsuitable for the clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase II. Overall response rate | 3 months post CAR-T cells infusion | Including complete response (CR) and partial response (PR) rates |
| Phase I. Safety | 1 month post CAR-T cells infusion | Number of Participants With Grade 3-5 Toxicities. Adverse events will be graded according to the CTCAE v5.0 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Phase I. CAR-T proliferation | 3 months post CAR-T cells infusion | To explore the pharmacokinetics of CAR-T cells: duration of expansion of CAR-T cells by flow cytometry, peak of expansion of CAR-T cells |
| Phase II. Efficacy: Overall survival rates | 12 months post CAR-T cells infusion | Overall survival rates |
| Phase II. Progression-free survival rates | 12 months post CAR-T cells infusion | progression-free survival time |
| Phase II. Duration of response | 12 months post CAR-T cells infusion | duration of response |
Countries
Belarus
Outcome results
None listed