Phase 1/2 Dose Escalation Study of CD19/CD22 Bicistronic Chimeric Antigen Receptor (CAR) T Cells in Children and Young Adults With Recurrent or Refractory CD19/CD22-expressing B Cell Malignancies

10000324

Background: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. About 90% of children and young adults who are treated for ALL can now be cured. But if the disease comes back, the survival rate drops to less than 50%. Better treatments are needed for ALL relapses. Objective: To test chimeric antigen receptor (CAR) therapy. CARs are genetically modified cells created from each patient s own blood cells. his trial will use a new type of CAR T-cell that is targeting both CD19 and CD22 at the same time. CD19 and CD22 are proteins found on the surface of most types of ALL. Eligibility: People aged 3 to 35 with ALL or related B-cell lymphoma that has not been cured by standard therapy. Design: Participants will be screened. This will include: Physical exam Blood and urine tests Tests of their lung and heart function Imaging scans Bone marrow biopsy. A large needle will be inserted into the body to draw some tissues from the interior of a bone. Lumbar puncture. A needle will be inserted into the lower back to draw fluid from the area around the spinal cord. Participants will undergo apheresis. Their blood will circulate through a machine that separates blood into different parts. The portion containing T cells will be collected; the remaining cells and fluids will be returned to the body. The T cells will be changed in a laboratory to make them better at fighting cancer cells. Participants will receive chemotherapy starting 4 or 5 days before the CAR treatment. Participants will be admitted to the hospital. Their own modified T cells will be returned to their body. Participants will visit the clinic 2 times a week for 28 days after treatment. Follow-up will continue for 15 years....

2022-12-28

2027-07-01

2029-07-01

Recruiting

Early phase I

116

* INCLUSION CRITERIA: * Diagnosis * Participant must: * Have pathology confirmed B cell ALL (not isolated to the testis or CNS), CML with ALL transformation, or high-grade lymphoma (e.g., Burkitt s lymphoma, B-lymphoblastic lymphoma, diffuse large B-cell lymphoma, inclusive of low-grade lymphoma that has transformed to high grade disease); and * Have relapsed or been refractory after at least one standard chemotherapy regimen and at least one salvage treatment. Participants with Philadelphia chromosome + ALL must have failed prior tyrosine kinase inhibitor; and * Be ineligible for allogeneic stem cell transplant (SCT), have refused SCT, or have recurred after SCT; and * Have no evidence of graft-versus- host disease (GVHD) and have been without immunosuppressive agents for at least 30 days prior to apheresis, if undergone prior allogeneic SCT; and * Be unable to access (in a timely manner), ineligible for, or have relapsed/failed after or not responded to a commercially available CD19 CAR T-cell construct; and * Have evidence of at least minimal residual disease or PET-avid disease (lymphoma) at the time of enrollment. * CD22/CD19 expression * CD19 must be detected on \>15% of the malignant cells by immunohistochemistry or \> 80% by flow cytometry. * CD22 positivity must be confirmed. * Age \>= 3 years of age and \<=35 years of age at time of enrollment. * Clinical Performance status: Participants \>= 16 years of age: Karnofsky \>= 50%; Participants \< 16 years of age: Lansky scale \>= 50%. * Participants must have adequate organ and marrow function as defined below: * leukocytes \>= 750/mcL\* * platelets \>= 50,000/mcL\* * total bilirubin \<=2 X ULN (except in the case of participants with documented Gilbert s disease \> 3x ULN) * AST(SGOT)/ALT(SGPT) \<=10 x institutional upper limit of normal * creatinine \<= the maximum for age listed in the table below OR * measured creatinine clearance \>=60 mL/min/1.73 m\^2 for participants with creatinine levels above the max listed below per age. * Age (Years) \<= 5 \|\| Maximum Serum Creatinine (mg/dL) \<= 0.8 * Age (Years) 6 to \<= 10 \|\| Maximum Serum Creatinine (mg/dL) \<= 1.0 * Age (Years) \>10 \|\| Maximum Serum Creatinine (mg/dL) \<= 1.2 * a participant will not be excluded because of pancytopenia \>= Grade 3 if it is due to underlying bone marrow involvement by leukemia * Central nervous system (CNS) Status * Participants with leukemia with CNS 1 and 2 disease are eligible in the absence of exclusion criteria * Participants of child-bearing or child-fathering potential must be willing to practice effective birth control from the time of enrollment until four months following lymphodepletion (LD) * Participants who are breastfeeding or plan to breastfeed must agree to discontinue/postpone breastfeeding while on study therapy and until 1 month after the administration of CAR. * Cardiac function: Left ventricular ejection fraction \>= 45% or fractional shortening \>=28% * Pulmonary Function * Baseline oxygen saturation \>92% on room air at rest * Ability of participant or Legally Authorized Representative (LAR) to understand and the willingness to sign a written informed consent document. * Ability and willingness of participant or Legally Authorized Representative (LAR) to co- enroll on 15-C-0028: Follow-up Evaluation for Gene-Therapy Related Delayed Adverse Events after Participation in Pediatric Oncology Branch Clinical Trials. EXCLUSION CRITERIA: Participants meeting any of the following criteria are not eligible for participation in the study: * Participants with CNS3 disease, neurologic signs of CNS disease, radiologically detected active CNS lymphoma * Hyperleukocytosis (\>= 50,000 blasts/microL) * Positive serum or urine beta-HCG pregnancy test performed at screening. * Participants will be excluded based on prior therapy if they fail to meet following washout criteria: * Therapy: Systemic Chemotherapy, anti-neoplastic agents, antibody- based therapies * Washout\*: \>=2 weeks * Exceptions: 6 weeks for clofarabine or nitrosoureas; No washout for prior intrathecal chemotherapy, steroid therapy, hydroxyurea (no dose increases within prior 2 weeks) or ALL maintenance-type chemotherapy (vincristine, 6-mercaptopurine, oral methotrexate, or a tyrosine kinase inhibitor for participants with Ph+ ALL) provided there is recovery from any acute toxic effects * Therapy: Radiation * Washout\*: \>=3 weeks * Exceptions: No time restriction with radiation therapy if the volume of bone marrow treated is less than 10% and the participant has measurable/evaluable disease outside the radiation window * Therapy: Allogeneic Stem Cell Transplant * Washout\*: \>= 100 days since SCT; \>= 30 days since completion of immunosuppression; \>= 6 weeks since donor lymphocyte infusion (DLI) * Exceptions: Cannot have evidence of active graft-versus-host disease (GVHD) * Therapy: CAR T-Cell Therapy or other Adoptive Cell Therapy * Washout\*: \> 30 days post infusion * Exceptions: For patients previously treated with CAR T-cells without interim HSCT (cohorts B1 and D1) cannot have circulating CAR T cells (or genetically modified cells) \>5% by flow cytometry in peripheral blood * Washout: Time between therapy and apheresis * Positive HIV antibodies consistent with active HIV. * Positive hepatitis C antibodies or positive Hepatitis B surface antigen (HbsAG) indicative of current/active HCV/HBV. * Active second malignancy other than in situ carcinoma of the cervix, unless the tumor was treated with curative intent at least two years previously and participant is in remission. * History of severe, immediate hypersensitivity reaction attributed to compounds of similar chemical or biologic composition to any agents used in study or in the manufacturing of the cells. * Uncontrolled, symptomatic, intercurrent illness or social situations that would limit compliance with study requirements or in the opinion of the PI would pose an unacceptable risk to the participant.

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2024-06-06