Autologous T-Cells Expressing a Second Generation CAR for Treatment of T-Cell Malignancies Expressing CD5 Antigen (MAGENTA)
T-cell Acute Lymphoblastic Lymphoma, T-non-Hodgkin Lymphoma, T-cell Acute Lymphoblastic Leukemia
About this trial
This is an interventional treatment trial for T-cell Acute Lymphoblastic Lymphoma focused on measuring Autologous CAR T cells, T-cell acute lymphoblastic lymphoma, T-non-Hodgkin Lymphoma, T-cell Acute Lymphoblastic Leukemia, Allogeneic CAR T cells
Eligibility Criteria
Procurement Inclusion Criteria
Referred patients (Group A) or their previous HSCT donors (Group B) will initially be consented for procurement of blood for generation of the transduced ATL. Patient eligibility criteria at this stage include:
Diagnosis of recurrent T-cell acute lymphoblastic leukemia (T-ALL), T-cell acute lymphoblastic lymphoma (T-LLy), or T-non-Hodgkin lymphoma (T-NHL, including Angioimmunoblastic T-cell lymphoma (AITL), Enteropathy-associated T-cell lymphoma (EATL), Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), Peripheral T-cell lymphoma (PTCL) NOS, Anaplastic large cell lymphoma (ALCL), Adult T-cell leukemia/lymphoma, T cell prolymphocytic leukemia with symptomatic disease, Extranodal NK/T cell lymphoma, Mycosis fungoides/ Sezary Syndrome Stage IIB or higher)
AND
Group A (auto arm): Transplant naïve or relapsed post-allogeneic HSCT
OR
Group B (allo arm): Relapsed post-allogeneic HSCT with previous HSCT donor from whom allogeneic MAGENTA CAR T cells can be manufactured
AND
- Suitable for allogeneic hematopoietic stem cell transplant (HSCT) with confirmation of an identified eligible allo-HSCT donor by FACT accredited institution
- Confirmation that the center plans to proceed with transplant if CD5.CAR treatment induces a complete remission.
- CD5-positive tumor (result can be pending at this time). > 50% CD5 + blasts by flow cytometry or immunohistochemistry (tissue) assessed by a CLIA certified Flow Cytometry/Pathology laboratory.
- Age less than or equal to 75 years old. NOTE: The first six (6) patients treated on the study will be adults (>18 yrs of age).
- Hgb greater than or equal to 7.0 (can be transfused)
- Life expectancy greater than 12 weeks
If pheresis required to collect blood:
- Creatinine <1.5 × upper limit normal
- AST <1.5 × upper limit normal
- PT and APTT <1.5 × upper limit normal
- Patients must have an available partially-HLA matched allogeneic EBV-specific T cell line on a BCM IRB approved protocol which can be used as treatment in the event of uncontrolled EBV reactivation
- Informed consent explained to, understood by and signed by patient/guardian. Patient/guardian given copy of informed consent.
Procurement Exclusion Criteria:
- Active infection requiring antibiotics.
- Active infection with HIV.
- Clinically significant viral infection or uncontrolled viral reactivation of EBV, CMV, Adv, BK-virus, or HHV-6.
- History of other cancer (except non-melanoma skin cancer or in situ breast cancer or cervix cancer) unless the tumor was successfully treated with curative intent at least 2 years before trial entry.
Treatment Inclusion Criteria:
Diagnosis of recurrent T-cell acute lymphoblastic leukemia (T-ALL), T-cell acute lymphoblastic lymphoma (T-LLy), or T-non-Hodgkin lymphoma (T-NHL, including Angioimmunoblastic T-cell lymphoma (AITL), Enteropathy-associated T-cell lymphoma (EATL), Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), Peripheral T-cell lymphoma (PTCL) NOS, Anaplastic large cell lymphoma (ALCL), Adult T-cell leukemia/lymphoma, T cell prolymphocytic leukemia with symptomatic disease, Extranodal NK/T cell lymphoma, Mycosis fungoides/ Sezary Syndrome Stage IIB or higher)
AND Group A (auto arm): Transplant naïve or relapsed post-allogeneic HSCT
OR
Group B (allo arm): Relapsed post-allogeneic HSCT with previous HSCT donor from whom allogeneic MAGENTA CAR T cells can be manufactured.
AND
- Suitable for allogeneic hematopoietic stem cell transplant (HSCT) with confirmation of an identified eligible allo-HSCT donor by FACT accredited institution
- Confirmation that the center plans to proceed with transplant if CD5.CAR treatment induces a complete remission.
- Age less than or equal to 75 years old. NOTE: The first six (6) patients treated on the study will be adults (>18 yrs of age).
- Bilirubin less than 3 times the upper limit of normal.
- AST less than 5 times the upper limit of normal.
- Estimated GFR > 60 mL/min.
- Pulse oximetry of > 90% on room air
- Karnofsky or Lansky score of greater than or equal to 60%.
- Recovered from acute toxic effects of prior chemotherapy at least one week before entering this study.
- ≥ 60 days post-allogeneic HSCT at time of treatment.
- Life expectancy of greater than 12 weeks.
- Patients must have an available partially-HLA matched allogeneic EBV-specific T cell line on a BCM IRB approved protocol which can be used as treatment in the event of uncontrolled EBV reactivation.
- Sexually active patients must be willing to utilize one of the more effective birth control methods during the study and for 6 months after the study is concluded. The male partner should use a condom.
- Informed consent explained to, understood by, and signed by patient/guardian. Patient/guardian given copy of informed consent.
Treatment Exclusion Criteria:
- Currently receiving any investigational agents or having received any tumor vaccines within the previous 6 weeks.
- History of hypersensitivity reactions to murine protein-containing products.
- Pregnant or lactating.
- Tumor in a location where enlargement could cause airway obstruction.
- Active infection with HIV.
- Clinically significant viral infection or uncontrolled viral reactivation of EBV, CMV, Adv, BK-virus, or HHV-6.
- Evidence of acute GVHD > Grade II or active chronic GVHD > mild global severity score
- Currently taking corticosteroids for therapy of GVHD at a dose of >0.5mg/kg prednisone equivalent
- Patients who have received Immunosuppressive Treatment (IST) for GVHD within 28 days of infusion
- Patients who have received donor lymphocyte infusion (DLI) within 28 days of infusion
- Any of the following cardiac criteria: Atrial fibrillation/flutter; Myocardial infarction within the last 12 months; Prolonged QT syndrome or secondary prolonged QT, per investigator discretion. Cardiac echocardiography with LVSF<30% or LVEF<50%; or clinically significant pericardial effusion. Cardiac dysfunction NYHA III or IV (Confirmation of absence of these conditions within 12 months of treatment)
- CNS abnormalities: Presence of CNS-3 disease defined as detectable cerebrospinal blast cells in a sample of CSF with greater than or equal to 5 WBCs per mm3; History or presence of any CNS disorder such as a uncontrolled seizure disorder, cerebrovascular ischemia/hemorrhage within prior 6 months, dementia, cerebellar disease, or any autoimmune disease with CNS involvement.
Sites / Locations
- Houston Methodist HospitalRecruiting
- Texas Children's HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Autologous CD5.CAR/28zeta CAR T cells (Group A)
Allogeneic CD5.CAR/28zeta CAR T cells (Group B)
Three dose levels will be evaluated. The T cells will be administered with Cytoxan and fludarabine.If patients have experienced either a partial response or stable disease and completed the 6 week toxicity evaluation without evidence of DLT or other infectious complications, they will be eligible to receive up to 3 additional infusions of CD5 CAR.T cells. Patients remain eligible for up to 3 additional infusions as long as they continue to have a clinical response and absence of safety concerns. If patients experience a complete response following an additional infusion, investigators will recommend they proceed to allogeneic HSCT. Once dose escalation is completed, the trial will be expanded and treat up to an additional 6 patients (2 cohorts) at the MTD in each group to gather additional safety data and preliminary efficacy data.
Three dose levels will be evaluated. The T cells will be administered with Cytoxan and fludarabine.If patients have experienced either a partial response or stable disease and completed the 6 week toxicity evaluation without evidence of DLT or other infectious complications, they will be eligible to receive up to 3 additional infusions of CD5 CAR.T cells. Patients remain eligible for up to 3 additional infusions as long as they continue to have a clinical response and absence of safety concerns. If patients experience a complete response following an additional infusion, investigators will recommend they proceed to allogeneic HSCT. Once dose escalation is completed, the trial will be expanded and treat up to an additional 6 patients (2 cohorts) at the MTD in each group to gather additional safety data and preliminary efficacy data.