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A Phase I/II Study of Cellular Immunotherapy With Donor Central Memory-Derived Virus-Specific CD8+ T-Cells Engineered to Target CD19 for CD19+ Malignancies After Allogeneic Hematopoietic Stem Cell Transplant


Phase 1/Phase 2
18 Years
75 Years
Open (Enrolling)
Both
Philadelphia Chromosome Negative Adult Precursor Acute Lymphoblastic Leukemia, Recurrent Adult Acute Lymphoblastic Leukemia, Recurrent Adult Diffuse Large Cell Lymphoma, Recurrent Adult Immunoblastic Large Cell Lymphoma, Recurrent Mantle Cell Lymphoma, Refractory Chronic Lymphocytic Leukemia

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Trial Information

A Phase I/II Study of Cellular Immunotherapy With Donor Central Memory-Derived Virus-Specific CD8+ T-Cells Engineered to Target CD19 for CD19+ Malignancies After Allogeneic Hematopoietic Stem Cell Transplant


PRIMARY OBJECTIVES:

I. To assess the safety and feasibility of pre-emptive adoptive T cell therapy using ex vivo
expanded cytomegalovirus (CMV)- or Epstein-Barr virus (EBV)-specific T cells derived from
donor CD62L+ central memory (TCM) cells and genetically modified to express a CD19-specific
chimeric antigen receptor (CAR) in patients in complete remission after human leukocyte
antigen (HLA)-matched related donor hematopoietic stem cell transplantation (HCT) for CD19+
B cell malignancies at high risk of post-HCT relapse. (Cohort A)

II. To assess the safety and feasibility of adoptive T cell therapy using ex vivo expanded
CMV- or EBV-specific T cells derived from donor CD62L+ TCM cells and genetically modified to
express a CD19-specific CAR in patients with persistent, progressive or relapsed disease
after HLA-matched related donor HCT for CD19+ B cell malignancies. (Cohort B)

SECONDARY OBJECTIVES:

I. To determine the duration of in vivo persistence of adoptively transferred bi-specific
CD8+ T cells, and the phenotype of persisting T cells.

II. To determine if adoptively transferred bi-specific CD8+ T cells traffic to the bone
marrow and function in vivo.

III. To determine if adoptively transferred bi-specific CD8+ T cells proliferate in
allogeneic HCT recipients that reactivate CMV or EBV.

IV. To determine if the adoptive transfer of bi-specific CD8+ T cells eliminates CD19+ tumor
cells in the subset of patients with a measurable tumor burden prior to T cell transfer.

OUTLINE:

At least 30 days after HCT, patients will receive one intravenous (IV) infusion of CMV/CD19
or EBV/CD19 bi-specific CD8+ T cells.

After completion of study treatment, patients are followed up periodically for 15 years.


Inclusion Criteria:



- 1. Patients with

- CD19+ B cell malignancy who have persistent, relapsed or progressive disease
after peripheral blood stem cell transplant from an HLA-matched related donor

- OR

- CD19+ B cell malignancy who are planned for or have had a peripheral blood stem
cell transplant from an HLA-matched related donor after myeloablative or
non-myeloablative conditioning on a Fred Hutchinson Cancer Research Center
(FHCRC) transplant protocol and are at high risk of relapse after HCT defined by
any one of the disease-specific criteria listed below:

- a. Philadelphia chromosome negative acute lymphoblastic leukemia:

- i. Beyond first complete remission (CR) at the time of pre-transplant
evaluation

- ii. First morphologic CR but with evidence of minimal residual disease
by flow cytometry, conventional cytogenetics, fluorescence in situ
hybridization (FISH) or polymerase chain reaction (PCR) prior to
transplant

- iii. First CR with poor risk cytogenetics (t(4:11), t(8;14),
hypodiploidy, near triploidy or > 5 cytogenetic abnormalities) at
diagnosis

- b. Chronic lymphocytic leukemia, or low grade B cell lymphoma: Lymph nodes
greater than or equal to 5 cm at the time of pre-transplant evaluation

- c. Mantle cell lymphoma: Lymph nodes greater than or equal to 2 cm at the
time of pre-transplant evaluation

- d. Diffuse large B cell lymphoma, large B cell transformation of an
indolent lymphoma or other large B cell lymphoma: Not in CR by conventional
computed tomography (CT) criteria or in CR by conventional criteria but
with evidence of residual disease by a positive positron emission
tomography (PET) scan

- 2. Confirmation of tumor diagnosis and expression of CD19 after review by University
of Washington Medical Center (UWMC) or Seattle Cancer Care Alliance (SCCA) pathology
services

- 3. The patient has signed the informed consent form for this study

- DONOR: Genotypic or phenotypic HLA-identical family members

- DONOR: Express one or more of the following combinations of viral serostatus and HLA
allele:

- CMV seropositive and HLA-A*0101 positive

- CMV seropositive and HLA-A*0201 positive

- CMV seropositive and HLA-B*0702 positive

- CMV seropositive and HLA-B*0801 positive

- EBV seropositive and HLA-A*0201 positive

- EBV seropositive and HLA-B*0801 positive

- DONOR: Hematocrit >= 35% at enrollment

- DONOR: Age >= 18 years

- DONOR: The donor has signed the informed consent form for the study

Exclusion Criteria:

- Philadelphia chromosome positive acute lymphocytic leukemia

- Known central nervous system (CNS) tumor (CNS2 or CNS3) that is refractory to
intrathecal chemotherapy and/or cranio-spinal radiation; patients with a history of
CNS disease that has been effectively treated to CNS1 or lower evidence of disease
will be eligible

- Human immunodeficiency virus (HIV) seropositive

- Significant medical or psychological conditions that would make them unsuitable
candidates for T cell therapy

- Fertile patients unwilling to use contraception during and for 12 months after
protocol enrollment

- Pregnant or breast-feeding

- DONOR: G-CSF administered within one month prior to the blood draw for T cell
collection

- DONOR: Unable for any reason to provide a 400 ml blood draw

- DONOR: Inadequate peripheral veins for blood collection

- DONOR: HIV-1, HIV-2, human T-lymphotropic virus (HTLV)-1 or HTLV-2 seropositive

- DONOR: Active hepatitis B or hepatitis C virus infection

- DONOR: Positive serologic test for syphilis

- DONOR: Aberrant CD45RA isoform expression on all T cells

- DONOR: Systolic blood pressure (BP) < 80 or > 200

- DONOR: Heart rate < 50 or > 120, if considered due to cardiac disease

- DONOR: Oxygen (O2) saturation < 88% on room air

- DONOR: Serum creatinine (Cr) > 3.0

- DONOR: Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 4 x the
upper limit of normal

- DONOR: Unable to provide informed consent to participate

- DONOR: Significant medical conditions (e.g. immunosuppressive therapy) that would
make them unsuitable T cell donors

- DONOR: Pregnant or nursing

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Safety and toxicity assessment of study treatment

Outcome Description:

Incidence of grade >= 3 toxicity, as defined by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 occurring from the T cell infusion through day 42 after the T cell infusion. Analysis will be performed separately in patients in complete remission (cohort A) or with detectable disease (cohort B) at day 28 post-transplant (prior to the T cell infusion). Incidence of acute GVHD occurring from the T cell infusion through day 42 after the T cell infusion will be assessed.

Outcome Time Frame:

Up to day 42 after the T cell infusion

Safety Issue:

Yes

Principal Investigator

Cameron Turtle

Investigator Role:

Principal Investigator

Investigator Affiliation:

Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium

Authority:

United States: Food and Drug Administration

Study ID:

2494.00

NCT ID:

NCT01475058

Start Date:

April 2012

Completion Date:

Related Keywords:

  • Philadelphia Chromosome Negative Adult Precursor Acute Lymphoblastic Leukemia
  • Recurrent Adult Acute Lymphoblastic Leukemia
  • Recurrent Adult Diffuse Large Cell Lymphoma
  • Recurrent Adult Immunoblastic Large Cell Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Refractory Chronic Lymphocytic Leukemia
  • Leukemia
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Leukemia, Lymphoid
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Lymphoma
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Philadelphia Chromosome
  • Lymphoma, Large-Cell, Immunoblastic
  • Lymphoma, Mantle-Cell

Name

Location

Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Seattle, Washington  98109