Anti-CD22 Chimeric Receptor T Cells in Pediatric and Young Adults With Recurrent or Refractory CD22-expressing B Cell Malignancies

  • STATUS
    Recruiting
  • End date
    Jun 1, 2040
  • participants needed
    126
  • sponsor
    National Cancer Institute (NCI)
Updated on 3 May 2021
cancer
graft versus host disease
lymphoma
white blood cell count
flow cytometry
ejection fraction
immunosuppressive agents
cell transplantation
leukemia
colony stimulating factor
PCR test
chemotherapy drug
neutrophil count
chemotherapy drugs
blood cell count

Summary

Background
  • One type of cancer therapy takes blood cells from a person, changes them in a lab, then gives the cells back to the person. In this study, researchers are using an anti-CD22 gene, a virus, and an immune receptor to change the cells.
    Objective
  • To see if giving anti-CD22 Chimeric Antigen Receptor (CAR) cells to young people with certain cancers is safe and effective.
    Eligibility
  • People ages 1-30 with a leukemia or lymphoma that has not been cured by standard therapy.
    Design
  • Participants will be screened to ensure their cancer cells express the CD22 protein. They will also have medical history, physical exam, blood and urine tests, heart tests, scans, and x-rays. They may give spinal fluid or have bone marrow tests.
  • Participants may have eye and neurologic exams.
  • Participants will get a central venous catheter or a catheter in a large vein.
  • Participants will have white blood cells removed. Blood is removed through a needle in an arm. White blood cells are removed. The rest of the blood is returned by needle in the other arm.
  • The cells will be changed in a laboratory.
  • Participants will get two IV chemotherapy drugs over 4 days. Some will stay in the hospital for this.
  • All participants will be in the hospital to get anti-CD22 CAR cells through IV. They will stay until any bad side effects are gone.
  • Participants will have many blood tests. They may repeat some screening exams.
  • Participants will have monthly visits for 2-3 months, then every 3-6 months. They may repeat some screening exams.
  • Participants will have follow-up for 15 years.

Description

Background
  • Adoptive cellular therapy with T cells genetically modified using viral-based vectors to express chimeric antigen receptors targeting the CD19 molecule have demonstrated dramatic clinical responses in patients with acute lymphoblastic leukemia (ALL). However, not all patients respond and CD19-negative escape has been observed following CD19 CAR therapy, as well as anti-CD19/CD3 bispecific antibody therapy. Thus, additional targets are needed.
  • CD22 is a B-lineage-restricted, transmembrane phosphoglycoprotein of the Ig superfamily that is widely expressed on B-cell malignancies including 96% to 100% of pediatric Bprecursor ALL. Therefore, CD22 represents a promising target. Encouraging responses targeting CD22 with an antibody based immunoconjugate have been seen in patients, including children, with recurrent and refractory ALL. This will be the first in human testing of anti-CD22 CAR adoptive cell therapy.
    Objectives
  • To determine the feasibility of producing anti-CD22 CAR cells meeting established release criteria. Complete
  • To assess the safety of administering escalating doses of anti-CD22-CAR engineered T cells in children and young adults with recurrent or refractory CD22- expressing B cell malignancies following a cyclophosphamide/fludarabine preparative regimen.
    Eligibility
  • Patients 3-30 years of age, at least 14.5 kg, with CD22-expressing B-cell malignancies that have recurred after or not responded to one or more standard regimens and deemed incurable by standard therapy. Patients with a history of allogeneic hematopoietic transplantation (SCT) who meet all eligibility criteria are eligible to participate. Patients previously treated with anti-CD19 CAR engineered T cells are also eligible.
    Design
  • PBMC will be obtained by leukapheresis, CD3+ cells enriched and cultured in the presence of anti-CD3/-CD28 beads followed by lentiviral vector supernatant containing the anti-CD22 (M971BBz) CAR.
  • On Day -4 (cell infusion is Day 0), patients will begin induction chemotherapy comprising fludarabine 25 mg/m2 on Days -4, -3 and -2 and cyclophosphamide 900 mg/m2 on day 2.
  • The CD22-CAR cells will be infused on Day 0, with up to a 72h delay allowed for infusion of fresh cells or a 7 day delay if cells are cryopreserved, if needed for resolution of clinical toxicities, to generate adequate cell numbers, or to facilitate scheduling.
  • A phase I cell dose escalation scheme will be performed using 3 dose levels (3 x 10(5) transduced T cells/kg; 1 x 10(6) transduced T cells/kg; and 3 x 10(6) transduced T cells/kg;). If 2/6 patients have DLT at dose level 1, safety will be evaluated in a de-escalated dose of 1 x 10(5) transduced T cells/kg (more or less 20%)). Once the maximum tolerated dose (or highest level evaluated) is reached, enrollment into an expansion cohort of a total of 58 patients at MTD in (32 with and 26 without previous CD19 CAR T cells) will proceed to provide additional information regarding the feasibility, safety and efficacy of this treatment. Patients who have previously received CD19 CAR T cells will be evaluated separately from CAR-na(SqrRoot) ve patients as response may be different in these two groups.
  • Patients will be monitored for toxicity, response and T cell persistence as well as other biologic correlates.

Details
Condition childhood ALL, Follicular Lymphoma, Diffuse Large B-Cell Lymphoma, Lymphoma, Non-Hodgkin's Lymphoma, Lymphocytic Leukemia, Acute, leukemia, acute lymphoblastic, non-hodgkin's lymphoma (nhl), large cell lymphoma, acute lymphoid leukaemia, acute lymphocytic leukemia, acute lymphoblastic leukemia (all)
Treatment CD22-CAR
Clinical Study IdentifierNCT02315612
SponsorNational Cancer Institute (NCI)
Last Modified on3 May 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Do you have any of these conditions: acute lymphocytic leukemia or Follicular Lymphoma or Non-Hodgkin's Lymphoma or childhood ALL or large cell lymphoma or non-hodgkin's lymphoma (nhl) or...?
Do you have any of these conditions: Follicular Lymphoma or Lymphocytic Leukemia, Acute or Lymphoma or acute lymphocytic leukemia or acute lymphoid leukaemia or acute lymphoblastic leukem...?
Do you have any of these conditions: acute lymphocytic leukemia or Diffuse Large B-Cell Lymphoma or childhood ALL or large cell lymphoma or acute lymphoid leukaemia or Non-Hodgkin's Lymph...?
Do you have any of these conditions: Follicular Lymphoma or acute lymphocytic leukemia or Lymphocytic Leukemia, Acute or acute lymphoblastic leukemia (all) or large cell lymphoma or leuke...?
Do you have any of these conditions: Lymphocytic Leukemia, Acute or Non-Hodgkin's Lymphoma or large cell lymphoma or Lymphoma or leukemia, acute lymphoblastic or acute lymphocytic leukemi...?
Do you have any of these conditions: Lymphocytic Leukemia, Acute or Lymphoma or Non-Hodgkin's Lymphoma or Follicular Lymphoma or leukemia, acute lymphoblastic or large cell lymphoma or ac...?
Do you have any of these conditions: acute lymphoid leukaemia or Lymphoma or acute lymphocytic leukemia or Lymphocytic Leukemia, Acute or acute lymphoblastic leukemia (all) or Diffuse Lar...?
Do you have any of these conditions: Lymphocytic Leukemia, Acute or large cell lymphoma or Follicular Lymphoma or Diffuse Large B-Cell Lymphoma or acute lymphoid leukaemia or leukemia, ac...?
Do you have any of these conditions: Diffuse Large B-Cell Lymphoma or acute lymphoid leukaemia or Non-Hodgkin's Lymphoma or Follicular Lymphoma or leukemia, acute lymphoblastic or Lymphoc...?
Do you have any of these conditions: leukemia, acute lymphoblastic or large cell lymphoma or acute lymphoblastic leukemia (all) or Non-Hodgkin's Lymphoma or Follicular Lymphoma or Lymphoc...?
Is your age between 3 yrs and 30 yrs?
Do you have any of these conditions: Lymphoma or acute lymphocytic leukemia or leukemia, acute lymphoblastic or non-hodgkin's lymphoma (nhl) or acute lymphoid leukaemia or Lymphocytic Leu...?
Do you have any of these conditions: Non-Hodgkin's Lymphoma or Diffuse Large B-Cell Lymphoma or Follicular Lymphoma or Lymphoma or acute lymphoid leukaemia or childhood ALL or acute lymph...?
Do you have any of these conditions: Follicular Lymphoma or childhood ALL or leukemia, acute lymphoblastic or Non-Hodgkin's Lymphoma or Lymphocytic Leukemia, Acute or acute lymphoid leuka...?
Do you have any of these conditions: childhood ALL or acute lymphoblastic leukemia (all) or non-hodgkin's lymphoma (nhl) or large cell lymphoma or leukemia, acute lymphoblastic or Lymphom...?
Do you have any of these conditions: acute lymphoid leukaemia or Lymphocytic Leukemia, Acute or large cell lymphoma or acute lymphocytic leukemia or childhood ALL or Follicular Lymphoma o...?
Do you have any of these conditions: acute lymphoid leukaemia or Follicular Lymphoma or Lymphocytic Leukemia, Acute or large cell lymphoma or acute lymphoblastic leukemia (all) or Lymphom...?
Do you have any of these conditions: childhood ALL or Lymphoma or Diffuse Large B-Cell Lymphoma or acute lymphoblastic leukemia (all) or non-hodgkin's lymphoma (nhl) or Non-Hodgkin's Lymp...?
Do you have any of these conditions: childhood ALL or Lymphoma or Diffuse Large B-Cell Lymphoma or Lymphocytic Leukemia, Acute or Non-Hodgkin's Lymphoma or Follicular Lymphoma?
Gender: Male or Female
Patient must have a B cell ALL (inclusive of ALL blast transformation from CML) or lymphoma and must have relapsed or refractory disease after at least one standard chemotherapy regimen and one salvage regimen. In view of the PI and the primary oncologist, there must be no available alternative curative therapies and subjects must be either ineligible for allogeneic stem cell transplant (SCT), have refused SCT, recurred after SCT, or have disease activity that prohibits SCT at the time of enrollment
CD22 expression must be detected on greater than 15% of the malignant cells by immunohistochemistry or greater than 80% by flow cytometry. The choice of whether to use flow cytometry or immunohistochemistry will be determined by what is the most easily available tissue sample in each patent. In general, immunohistochemistry will be used for lymph node biopsies, flow cytometry will be used for peripheral blood and bone marrow samples and CSF when feasible
Patients must have measurable or evaluable disease at the time of enrollment, which may include any evidence of disease including minimal residual disease detected by flow cytometry, cytogenetics, or polymerase chain reaction (PCR) analysis
Greater than or equal to 3 years of age (and at least 14.5 kg) and less than or equal to 30 years of age at time of enrollment

Exclusion Criteria

Patients, parents/guardian(s), legally authorized representative (LAR), or durable power of attorney must be able to give consent and sign the informed consent document
Clinical performance status: Patients greater than or equal to 16 years of age: Karnofsky greater than or equal to 50%; Patients < 16 years of age: Lansky scale greater than or equal to 50%. Subjects who are unable to walk because of paralysis, but who are upright in a wheelchair will be considered ambulatory for the purpose of calculating the performance score
Patients of child-bearing or child-fathering potential must be willing to practice birth control from the time of enrollment on this study and for four months after receiving the preparative regimen
Patients must have adequate organ function as described below
Cardiac function: Left ventricular ejection fraction greater than or equal to 45% or fractional shortening greater than or equal to 28%
Pulmonary function: Patients without respiratory symptoms (e.g. dyspnea at rest, known requirement for supplemental oxygen therapy) and who have an oxygen saturation greater than or equal to 92% on room air, will be eligible. For patients not meeting this criteria, pulmonary function tests will be performed to confirm that the DLCO/VA/Adj is 50% of the normal predicted value corrected for hemoglobin and alveolar volume in order to meet eligibility.(For children who are unable to cooperate for PFTs, the criterion is: No evidence of dyspnea at rest, no exercise intolerance and no requirement for supplemental oxygen therapy. )
Hematologic function
Absolute neutrophil count greater than or equal to 750/mcL
Platelets greater than or equal to 50,000/mcl
A subject will not be excluded because of pancytopenia related to disease
Liver Function
\--AST (SGOT)/ALT (SGPT): less than or equal to 20 x institutional upper limit
of normal
\--Total bilirubin less than or equal to 2 x ULN (ecept in the case of
subjects with documented Gilbert s disease greater than or equal to 3 x ULN)
\. Renal Function: Normal creatinineCreatinine level < the maximum for age
listed in the table below OR creatinine clearance greater than or equal to 60
mL/min/1.73 m2 for patients with creatinine levels above institutional normal
less than or equal to 5 years old: maximum serum creatinine 0.8mg/dL
between 6 and 10 years old: maximum serum creatinine 1.0mg/dL
greater than 10 years old: maximum serum creatinine 1.2mg/dL 14. Patients with history of allogeneic stem cell transplantation are eligible if at least 100 days post-transplant, if there is no evidence of active GVHD and no longer taking immunosuppressive agents for at least 30 days prior to enrollment. 15. Patients previously treated with anti-CD19 CAR or other adoptive cell therapies will be eligible if all other eligibility criteria are met but will be evaluated as a separate strata from CAR-naive patients in the expansion phase. Circulating CAR T cells must be <5% in peripheral blood
EXCLUSION CRITERIA
Subjects meeting any of the following criteria are not eligible for
participation in the
study
Subjects with radiologically-detected active CNS lymphoma, leptomeningeal CNS disease or isolated CNS disease which are eligible for definitive CNS directed radiationtherapy will be excluded
Hyperleukocytosis (greater than or equal to 50,000 blasts/ L) or rapidly
progressive disease that in theestimation of the investigator and sponsor
would compromise ability to complete study therapy
\. Pregnant or breast-feeding females
\. Recent prior therapy
\. Systemic chemotherapy less than or equal to 2 weeks (6 weeks for
clofarabine or nitrosoureas) or radiation therapy less than or equal to 3
weeks prior to apheresis
Exceptions
There is no time restriction in regard to prior intrathecal chemotherapy provided there is complete recovery from any acute toxic effects of such
Subjects receiving hydroxyurea may be enrolled provided there has been no increase in dose for at least 2 weeks prior to starting apheresis
Patients who are on standard ALL maintenance type chemotherapy (vincristine, 6- mercaptopurine, oral methotrexate, or a tyrosine kinase inhibitor for patients with Ph+ ALL) may be enrolled provided that chemotherapy is discontinued at least 1
week prior to apheresis
d. Subjects receiving steroids may be enrolled, provided there has been no
increase in dose for at least 1 week prior to starting apheresis
e. For radiation therapy: Radiation therapy must have been completed at least
weeks prior to enrollment (including CNS radiation), with the exception that
there is no time restriction if the volume of bone marrow treated is less than
% and also the subject has measurable/evaluable disease outside the
radiation port
\. Other anti-neoplastic investigational agents, or antibody based therapies
currently or within 2 weeks prior to apheresis
\. Subjects must have recovered from the acute side effects of their prior
therapy, such that eligibility criteria are met. Cytopenias deemed to be
disease-related and not therapy-related are exempt from this exclusion
\. Prior CAR therapy within 30 days prior to apheresis or prior CAR therapy
at any time with evidence for persistence of CAR T cells in blood samples
(circulating levels of genetically modified cells of greater than or equal to
% by flow cytometry)
\. HIV/HBV/HCV Infection
Seropositive for HIV antibody. (Patients with HIV are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will beundertaken in patients receiving combination antiretroviral therapy in the future should study results indicate effectiveness.)
Seropositive for hepatitis C or positive for Hepatitis B surface antigen (HbsAG)
Uncontrolled, symptomatic, intercurrent illness including but not limited to infection, congestive heart failure, unstable angina pectoris, cardiac arrhythmia, psychiatric 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 subject
Second malignancy other than in situ carcinoma of the cervix, unless the tumor was treated with curative intent at least two years previously and subject 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 (i.e. gentamicin)
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