DALY II USA/ MB-CART2019.1 for DLBCL

Last updated: April 21, 2025
Sponsor: Miltenyi Biomedicine GmbH
Overall Status: Active - Recruiting

Phase

2

Condition

Lymphoma

Lymphoma, B-cell

Treatment

zamtocabtagene autoleucel (MB-CART2019.1)

Fludarabine

MB-CART2019.1

Clinical Study ID

NCT04792489
M-2018-344
  • Ages > 18
  • All Genders

Study Summary

DALY II USA is a phase II, multi-center, single arm study to evaluate the efficacy, safety, and pharmacokinetics of zamtocabtagene autoleucel (MB-CART2019.1) in patients with relapsed and/or refractory diffuse large B cell lymphoma (DLBCL) after receiving at least two lines of therapy. Additional cohorts include subjects with B-cell primary or secondary central nervous system (CNS) lymphoma (PCNSL) and (SCNSL), mantle cell lymphoma (MCL) and Richter's transformation (RT) after receiving at least one line of therapy.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Histologically confirmed B-cell non-Hodgkin's lymphoma:

  • DLBCL DLBCL or associated subtype, defined by WHO 2016 classification:

  • DLBCL not otherwise specified (NOS)

  • High-grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements

  • High-grade B cell lymphoma (NOS)

  • Primary mediastinal (thymic) large B cell lymphoma

  • Transformed lymphoma (e.g., transformed follicular, or marginal zone lymphoma,follicular lymphoma (FL Grade 3)

  • CNS Cohort only: B-cell primary or secondary central nervous system lymphoma (PCNSLor SCNSL)

  • Mantle Cell Lymphoma (MCL) Cohort: Histologically confirmed MCL determined byoverexpression of cyclin D1 or presence of t(11;14) (q13; q32) translocation

  • Richter's Transformation (RT) Cohort: Histologically confirmed Richter'stransformation (RT) to a diffuse large B-cell lymphoma (DLBCL) subtype fromunderlying CLL (clonally related)

  • Relapsed or refractory disease is defined for DLBCL (and associated subtypes)population as failure of 2 or more lines of chemotherapy including rituximab orequivalent and anthracycline and either having failed autologous stem celltransplant (ASCT), or ineligible, not intended for or not consenting to ASCT

  • Chemotherapy-refractory disease is defined as persistent disease after last line oftherapy or relapsed or persistent disease after prior ASCT for lymphoma

  • Disease relapse in subjects without prior ASCT is defined as relapse of diseaseafter the last dose of most recent therapy regimen

  • CNS Cohort: Subjects with relapsed/refractory PCNSL that have failed (or unable totolerate) at least first-line therapy.

  • No contraindications for MRI evaluation

  • CNS Cohort: Subjects with SCNSL must have relapsed or refractory disease afterhaving received at least one prior line of systemic therapy

  • Prior lines of systemic therapy should include an anti-CD20 monoclonal antibody andanthracycline containing chemotherapy regimen and/or with or without an autologousstem cell transplant

  • No contraindications for MRI evaluation

  • MCL Cohort: Subjects with relapsed/refractory disease after at least one priorsystemic treatment, that must include:

  • Cytotoxic rituximab-based chemotherapy regimen (eg, rituximab bendamustine, R-CHOP,R-DHAP, R-ARA-C) AND

  • BTK inhibitor

  • RT Cohort: Subject must have relapsed/refractory disease after at least one priorsystemic treatment following Richter's Transformation

  • Age ≥18 years

  • Eastern Cooperative Oncology Group (ECOG) performance status that is either 0 or 1at screening. ECOG performance status of 2 at screen is allowed if the decrease inperformance status is due to lymphoma

  • Measurable disease according to Lugano 2014 criteria for assessing FDG-PET/CT insystemic lymphoma (Cheson et al, 2014). Measurable disease according to IPCGcriteria will be assessed by brain/spine MRI for CNS disease

  • Subject must have a tumor biopsy sample (at least 16 unstained slides of tissue ortissue block) from the most recent relapse available prior to MB-CART2019.1infusion. If medically not feasible to obtain a biopsy from the most recent relapseand for cases when the amount of tissue is limited, the sponsor should be consulted,to confirm adequacy of the sample for study required analyses

  • No clinical suspicion of central nervous system (CNS) lymphoma (not applicable toCNS cohort)

  • If the subject has history of CNS disease (not applicable to CNS cohort), thenhe/she must have no signs or symptoms of CNS disease, have no active disease onmagnetic resonance imaging (MRI), have no large cell lymphoma present in cerebralspinal fluid (CSF), regardless of the number of white blood cells (WBCs)

  • If has history of cerebral vascular accident (CVA), the CVA event must be greaterthan 12 months prior to leukapheresis. Any neurological deficits must be stable

  • A creatinine clearance (as estimated by direct urine collection or Cockcroft-GaultEquation) > 45mL/min

  • Cardiac ejection fraction (EF) ≥ 45% as determined by an echocardiogram (ECHO) orMultigated Radionuclide Angiography (MUGA)

  • Resting O2 saturation >90% on room air

  • Serum alanine aminotransferase (ALT) / aspartate aminotransferase (AST)<5 times theUpper Limit of Normal (ULN) for age

  • Total bilirubin <1.5 mg/dl, except in individuals with Gilbert's syndrome

  • Absolute neutrophil count (ANC) > 1000/μL

  • Absolute lymphocyte count > 100/μL

  • Platelet count > 50,000/µL

  • Estimated life expectancy of more than 3 months other than primary disease

Exclusion

Exclusion Criteria:

  • Primary CNS lymphoma (not applicable to CNS cohort)

  • Richter's transformed DLBCL arising from chronic lymphocytic leukemia (CLL) (notapplicable to RT cohort)

  • Unable to give informed consent

  • Known history of infection with human immunodeficiency virus (HIV) or activehepatitis B (HBsAg positive). If there is a history of treated hepatitis B orhepatitis C, the viral load must be quantitative polymerase chain reaction (PCR)negative; antiviral prophylaxis is required if HBsAg negative and anti-HBc positive

  • Known history of infection with hepatitis C virus (anti-HCV positive) unless viralload is undetectable per quantitative PCR and/or nucleic acid testing.

  • Pharmacologically uncontrolled seizures.

  • Known history or presence of autoimmune CNS disease, such as multiple sclerosis,optic neuritis, or other immunologic or inflammatory disease

  • Presence of CNS disorder that, in the judgment of the investigator, may impair theability to evaluate neurotoxicity. For CNS Cohort:

  • Midline shift on MRI

  • Abnormal high CSF opening pressure and or CSF protein >150 mg/dL Recent (within 3months) whole brain radiotherapy (WBRT)

  • Active systemic fungal, viral, or bacterial infection

  • Pregnant or breast-feeding woman

  • Previous or concurrent malignancy with the following exceptions:

  • Adequately treated basal cell or squamous cell carcinoma (adequate wound healingrequired prior to study entry)

  • In situ carcinoma of the cervix or breast, treated curatively and without evidenceof recurrence for at least 2 years prior to the study

  • Adequately treated breast or prostate carcinoma on hormonal therapies such as Lupronor tamoxifen and in clinical remission of ≥ 2 years

  • A primary malignancy which has been completely resected / treated with curativeintent and in complete remission of ≥ 2 years

  • Severely immunocompromised subjects e.g., due to current treatment of non-neurologicautoimmune disease (e.g., Crohn's disease, rheumatoid arthritis, systemic lupuserythematosus).

  • Medical condition requiring prolonged use of systemic corticosteroids equivalent toprednisone >10 mg/day. For CNS cohort: Up to 2 mg/day dexamethasone (or equivalence)may be allowed at any time, higher doses allowed up to 7 days prior to apheresis orafter apheresis until lymphodepletion.

  • History of myocardial infarction, cardiac angioplasty or stenting, unstable angina,or other clinically significant cardiac disease within 6 months of enrollment

  • Concurrent radiotherapy (normal tissue sparing palliative radiotherapy allowed up totime of lymphodepletion). For systemic therapy, at least 2 weeks or 5 half-lives,whichever is shorter, must have elapsed at the time of scheduled leukapheresis.

  • Baseline dementia that would interfere with therapy or monitoring, determined usingImmune Effector Cell-Associated Encephalopathy (ICE) Assessment at baseline

  • History of severe immediate hypersensitivity reaction to any of the agents used inthis study

  • Refusal to participate in additional lentiviral gene therapy LTFU protocol

  • Prior CAR-T therapy for any indication or systemic gene modifying therapy for B-celllymphoma

  • Prior allogeneic stem cell transplant for any indication

  • Prior BITE antibodies for cancer therapy

  • Prior T cell receptor-engineered T cell therapy

Study Design

Total Participants: 248
Treatment Group(s): 5
Primary Treatment: zamtocabtagene autoleucel (MB-CART2019.1)
Phase: 2
Study Start date:
May 25, 2021
Estimated Completion Date:
December 31, 2028

Study Description

A prospective, single arm, open label, multi-center, phase II study of autologous T cells engineered against both CD19 and CD20 antigens for subjects with relapsed or refractory DLBCL after receiving at least two lines of therapy. The investigational agent is the MB-CART2019.1 cells. Additional cohorts include subjects with B-cell primary or secondary central nervous system (CNS) lymphoma (PCNSL) and (SCNSL), mantle cell lymphoma (MCL) and Richter's transformation (RT) after receiving at least one line of therapy. After successful screening, subjects will undergo leukapheresis to collect product for manufacturing. In preparation for the fresh product infusion, subjects will undergo a lymphodepleting regimen with cyclophosphamide and fludarabine, or bendamustine. Cell infusion will be administered intravenously at a dose of 2.5 x 106 CAR+ cells/kg body weight. The study will start with enrollment of 3 subjects in the lead-in safety phase, and after safety is evaluated, the study will continue with enrollment of the remaining subjects. Subjects will be followed for up to 2 years, for efficacy and safety outcomes as well as health-related quality of life (HRQol). Additional long-term follow-up will be conducted for participants under a separate long-term follow-up protocol.

Connect with a study center

  • University of Alberta Cross Cancer Institute

    Edmonton, Alberta AB T6G 1Z2
    Canada

    Active - Recruiting

  • Princess Margaret Cancer Centre

    Toronto, Ontario ON M5G 2C4
    Canada

    Active - Recruiting

  • Banner MD Anderson Cancer Center

    Gilbert, Arizona 85234
    United States

    Active - Recruiting

  • Mayo Clinic

    Phoenix, Arizona 85054
    United States

    Active - Recruiting

  • UC San Diego Health

    La Jolla, California 92037
    United States

    Active - Recruiting

  • Stanford University

    Stanford, California 94305
    United States

    Active - Recruiting

  • Yale University

    New Haven, Connecticut 06520
    United States

    Active - Recruiting

  • Baptist Health Miami Cancer Institute

    Miami, Florida 33176
    United States

    Active - Recruiting

  • Winship Cancer Institute of Emory University

    Atlanta, Georgia 30322
    United States

    Active - Recruiting

  • Georgia Cancer Center at Augusta University

    Augusta, Georgia 30912
    United States

    Active - Recruiting

  • Robert H Lurie Cancer Center

    Chicago, Illinois 60611
    United States

    Active - Recruiting

  • University of Kansas Cancer Center

    Westwood, Kansas 66205
    United States

    Active - Recruiting

  • University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center

    Baltimore, Maryland 21201
    United States

    Active - Recruiting

  • Dana Farber Cancer Institute

    Boston, Massachusetts 02215
    United States

    Active - Recruiting

  • University of Michigan

    Ann Arbor, Michigan 48109
    United States

    Active - Recruiting

  • Mayo Clinic

    Rochester, Minnesota 55905
    United States

    Active - Recruiting

  • University of Nebraska Medical Center

    Omaha, Nebraska 68198
    United States

    Terminated

  • Memorial Sloan Kettering Cancer Center

    New York, New York 10065
    United States

    Active - Recruiting

  • Duke University Medical Center - Division of Hematologic Malignancies

    Durham, North Carolina 27705
    United States

    Active - Recruiting

  • The Ohio State University Wexner Medical Center James Cancer

    Columbus, Ohio 43210
    United States

    Active - Recruiting

  • Oregon Health and Science University Knight Cancer Institute

    Portland, Oregon 97239
    United States

    Active - Recruiting

  • Allegheny Health Network Cancer Institute

    Pittsburg, Pennsylvania 15212
    United States

    Active - Recruiting

  • Allegheny Health Network Cancer Institute

    Pittsburgh, Pennsylvania 15212
    United States

    Active - Recruiting

  • University of Pittsburgh - Hillman Cancer Center

    Pittsburgh, Pennsylvania 15260
    United States

    Site Not Available

  • UT Southwestern Medical Center

    Dallas, Texas 75390
    United States

    Active - Recruiting

  • Froedtert Hospital and the Medical College of Wisconsin

    Milwaukee, Wisconsin 53226
    United States

    Active - Recruiting

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