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HA-1 T TCR T Cell Immunotherapy for the Treatment of Patients With Relapsed or Refractory Acute Leukemia After Donor Stem Cell Transplant

Primary Purpose

Juvenile Myelomonocytic Leukemia, Recurrent Acute Biphenotypic Leukemia, Recurrent Acute Undifferentiated Leukemia

Status
Suspended
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CD8+ and CD4+ Donor Memory T-cells-expressing HA1-Specific TCR
Fludarabine
Laboratory Biomarker Analysis
Sponsored by
Fred Hutchinson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Juvenile Myelomonocytic Leukemia focused on measuring HA-1, TCR, Immunotherapy, Leukemia

Eligibility Criteria

undefined - 75 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient age 0-75 years at the time of enrollment. Initially only patients who are >= 16 years old will receive HA-1-TCR T cell infusions on the protocol. Younger patients may be screened, enrolled in the protocol and monitored for relapse but will not be eligible for infusion until at least one patient >=16 years old has been treated and discussed with the Food and Drug Administration (FDA)
  • Patients must express HLA-A*0201
  • Patients must have the HA-1(H) genotype (RS_1801284: A/G, A/A)
  • Patients must have an adult donor for HCT who is adequately HLA matched by institutional standards (includes HLA-matched related or unrelated donors, and HLA-mismatched family donors, including haploidentical donors) and is either:

    • HLA-A*0201 positive and HA-1(H) negative (RS_1801284: G/G) or
    • HLA-A*0201 negative
  • Patients who are currently undergoing or who previously underwent allogeneic HCT for

    • Acute myeloid leukemia (AML) of any subtype
    • Acute lymphoid leukemia (ALL) of any subtype
    • Mixed phenotype/undifferentiated/any other type of acute leukemia, including blastic plasmacytoid dendritic cell neoplasm
    • Chronic myeloid leukemia with a history of blast crisis and:

      • With relapse or refractory disease (>= 5% marrow blasts, or circulating blasts) at any time after HCT
      • With persistent rising minimal residual disease (defined as detectable disease by morphology, flow cytometry, molecular or cytogenetic testing but < 5% marrow blasts by morphology, no circulating blasts on >= 2 of two consecutive tests), refractory or ineligible for treatment with tyrosine kinase inhibitors at any time after HCT
    • Myelodysplastic syndrome (MDS) of any subtype
    • Chronic myelomonocytic leukemia (CMML)
    • Juvenile myelomonocytic leukemia (JMML)
  • Patients must be able to understand and be willing to give informed consent; decision-impaired adults may consent with their legally authorized representative; parent or legal representative will be asked to consent for patients younger than 18 years old
  • Patients must agree to participate in long-term follow-up for up to 15 years if they are enrolled in the study and receive T cell infusion
  • Patients who have relapsed or have MRD after HCT may receive other agents for treatment of disease and remain eligible for the protocol
  • A specific performance status score is not required for enrolling on the protocol; a delay in infusion of the HA-1 TCR T cells may be required for patients with low performance status

DONOR SELECTION INCLUSION

  • Donor age >= 18 years
  • Donors must be able to give informed consent
  • Patients must have an adult donor for HCT who is adequately HLA matched by institutional standards (includes HLA-matched related or unrelated donors, and HLA-mismatched family donors, including haploidentical donors) and is either:

    • HLA-A*0201 positive and HA-1(H) negative (RS_1801284: G/G) or
    • HLA-A*0201 negative

Exclusion Criteria:

  • Medical or psychological conditions that would make the patient unsuitable candidate for cell therapy at the discretion of the principal investigator (PI)
  • Fertile patients unwilling to use contraception during and for 12 months after treatment
  • Patients with a life expectancy < 3 months of enrollment from coexisting disease other than leukemia
  • Patients who develop grade IV acute GVHD or severe chronic GVHD following most recent transplant prior to enrollment on the protocol
  • The presence of organ toxicities will not necessarily exclude patients from enrolling on the protocol at the discretion of the PI; however, a delay in the infusion of HA-1 TCR T cells may be required

DONOR SELECTION EXCLUSION

  • Donors who are HIV-1, HIV-2, human T-lymphotropic virus (HTLV)-1, HTLV-2 seropositive or with active hepatitis B or hepatitis C virus infection
  • Unrelated donor residing outside of the United States of America (USA) unless the donor screening, testing and leukapheresis occur at an NMDP-affiliated and qualified donor center and are facilitated by the NMDP.

Sites / Locations

  • Fred Hutch/University of Washington Cancer Consortium

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (CD4+ and CD8+ HA-1 TCR T cells)

Arm Description

Patients receive fludarabine for 1-3 doses 3-14 days prior to HA-1 TCR T cell administration. Patients then receive CD4+ and CD8+ HA-1 TCR T cells IV over 1 hour.

Outcomes

Primary Outcome Measures

Feasibility of manufacturing minor H antigen (HA-1) T cell receptor (TCR) CD8+ and CD4+ T cells
Proportion of participants for whom a HA-1 TCR T cell product can be produced.
Feasibility of administering minor H antigen (HA-1) T cell receptor (TCR) CD8+ and CD4+ T cells
Proportion of participants for whom a HA-1 TCR T cell product can be administered.
Incidence of dose-limiting toxicities of HA-1 T cell receptor (TCR) T cells
Toxicities will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.

Secondary Outcome Measures

Duration of in vivo persistence of transferred HA-1 T cell receptor (TCR) CD4+ T cells in peripheral blood
Evaluated by tetramer and/or molecular tracking e.g. quantitative polymerase chain reaction (qPCR).
Duration of in vivo persistence of transferred HA-1 T cell receptor (TCR) CD8+ T cells in peripheral blood
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Presence, proportion and persistence of HA-1 T cell receptor (TCR) CD4+ T cells in the bone marrow
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Presence, proportion and persistence of HA-1 T cell receptor (TCR) CD8+ T cells in the bone marrow
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Specific cytolytic activity of HA-1 T cell receptor (TCR) CD8+ and CD4+ T cells against HLA-A*0201+ HA-1+ target cells before adoptive T cell transfer
Assessed by in vitro chromium release assay or equivalent cytotoxicity assay.
Specific cytolytic activity of HA-1 T cell receptor (TCR) CD8+ and CD4+ T cells against HLA-A*0201+ HA-1+ target cells after adoptive T cell transfer
By in vitro chromium release assay or flow cytometric degranulation assay (CD107a) using samples of peripheral blood and/or bone marrow collected from patients after adoptive T cell transfer.
Reduction of leukemia in the bone marrow in patients who have measurable leukemia in the marrow prior to HA-1 T cell receptor (TCR) T cell infusion
Quantified by flow cytometry to determine percentage of leukemic cells in the marrow.
Reduction of recipient normal hematopoietic cells in the bone marrow in patients who have measurable recipient normal hematopoietic cells in the marrow prior to HA-1 T cell receptor (TCR) T cell infusion
Quantified by variable number tandem repeat (VNTR) to determine percentage of normal recipient and donor cells in the marrow.
Proportion of patients who develop new or recurrent symptoms or signs of graft-versus-host disease
Assessed using clinical evaluation and standard clinical graft versus host disease (GVHD) grading criteria

Full Information

First Posted
October 5, 2017
Last Updated
September 26, 2023
Sponsor
Fred Hutchinson Cancer Center
Collaborators
HighPass Bio, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03326921
Brief Title
HA-1 T TCR T Cell Immunotherapy for the Treatment of Patients With Relapsed or Refractory Acute Leukemia After Donor Stem Cell Transplant
Official Title
Phase I Study of Adoptive Immunotherapy With CD8+ and CD4+ Memory T Cells Transduced to Express an HA-1-Specific T Cell Receptor (TCR) for Children and Adults With Recurrent Acute Leukemia After Allogeneic Hematopoietic Stem Cell Transplantation (HCT)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Suspended
Why Stopped
Pause in funding
Study Start Date
February 23, 2018 (Actual)
Primary Completion Date
October 16, 2024 (Anticipated)
Study Completion Date
July 16, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fred Hutchinson Cancer Center
Collaborators
HighPass Bio, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase I trial studies the side effects and best dose of CD4+ and CD8+ HA-1 T cell receptor (TCR) (HA-1 T TCR) T cells in treating patients with acute leukemia that persists, has come back (recurrent) or does not respond to treatment (refractory) following donor stem cell transplant. T cell receptor is a special protein on T cells that helps them recognize proteins on other cells including leukemia. HA-1 is a protein that is present on the surface of some peoples' blood cells, including leukemia. HA-1 T cell immunotherapy enables genes to be added to the donor cells to make them recognize HA-1 markers on leukemia cells.
Detailed Description
OUTLINE: This is a dose-escalation study of CD4+ and CD8+ HA-1 TCR T cells. Patients receive fludarabine for 1-3 doses 3-14 days prior to HA-1 TCR T cell administration. Patients then receive CD4+ and CD8+ HA-1 TCR T cells intravenously (IV) over 1 hour. After completion of study treatment, patients are followed up closely for 12 weeks and then every 6 months for years 1-5, and every year for years 6-15.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Juvenile Myelomonocytic Leukemia, Recurrent Acute Biphenotypic Leukemia, Recurrent Acute Undifferentiated Leukemia, Recurrent Childhood Acute Lymphoblastic Leukemia, Recurrent Childhood Acute Myeloid Leukemia, Refractory Acute Lymphoblastic Leukemia, Refractory Adult Acute Lymphoblastic Leukemia, Blast Phase Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Recurrent Blastic Plasmacytoid Dendritic Cell Neoplasm, Recurrent Myelodysplastic Syndrome, Refractory Blastic Plasmacytoid Dendritic Cell Neoplasm, Refractory Myelodysplastic Syndrome, Acute Undifferentiated Leukemia, Mixed Phenotype Acute Leukemia, Recurrent Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Refractory Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Recurrent Acute Lymphoblastic Leukemia, Recurrent Acute Myeloid Leukemia, Myelodysplastic Syndrome, Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Acute Biphenotypic Leukemia, Chronic Myeloid Leukemia, Chronic Myelomonocytic Leukemia, Minimal Residual Disease, Recurrent Chronic Myelomonocytic Leukemia, Recurrent Mixed Phenotype Acute Leukemia, Leukemia
Keywords
HA-1, TCR, Immunotherapy, Leukemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment (CD4+ and CD8+ HA-1 TCR T cells)
Arm Type
Experimental
Arm Description
Patients receive fludarabine for 1-3 doses 3-14 days prior to HA-1 TCR T cell administration. Patients then receive CD4+ and CD8+ HA-1 TCR T cells IV over 1 hour.
Intervention Type
Biological
Intervention Name(s)
CD8+ and CD4+ Donor Memory T-cells-expressing HA1-Specific TCR
Other Intervention Name(s)
CD8+ and CD4+ Donor Memory T-cells-expressing pRRLSIN iC9-HA1 TCR2-RQR-CD8, HA-1 TCR CD8+ and CD4+ Tm Cells, HA-1 TCR T Cells
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
Fluradosa, 2-Fluoro-9-beta-arabinofuranosyladenine, 2-Fluorovidarabine, 21679-14-1, 9-Beta-D-arabinofuranosyl-2-fluoro-9H-purin-6-amine, 9-Beta-D-arabinofuranosyl-2-fluoroadenine
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Feasibility of manufacturing minor H antigen (HA-1) T cell receptor (TCR) CD8+ and CD4+ T cells
Description
Proportion of participants for whom a HA-1 TCR T cell product can be produced.
Time Frame
At time of T cell infusion (at day 0)
Title
Feasibility of administering minor H antigen (HA-1) T cell receptor (TCR) CD8+ and CD4+ T cells
Description
Proportion of participants for whom a HA-1 TCR T cell product can be administered.
Time Frame
At time of T cell infusion (at day 0)
Title
Incidence of dose-limiting toxicities of HA-1 T cell receptor (TCR) T cells
Description
Toxicities will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.
Time Frame
Up to 12 weeks after T-cell infusion
Secondary Outcome Measure Information:
Title
Duration of in vivo persistence of transferred HA-1 T cell receptor (TCR) CD4+ T cells in peripheral blood
Description
Evaluated by tetramer and/or molecular tracking e.g. quantitative polymerase chain reaction (qPCR).
Time Frame
Up to 1 year
Title
Duration of in vivo persistence of transferred HA-1 T cell receptor (TCR) CD8+ T cells in peripheral blood
Description
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Time Frame
Up to 1 year
Title
Presence, proportion and persistence of HA-1 T cell receptor (TCR) CD4+ T cells in the bone marrow
Description
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Time Frame
Up to 1 year
Title
Presence, proportion and persistence of HA-1 T cell receptor (TCR) CD8+ T cells in the bone marrow
Description
Evaluated by tetramer and/or molecular tracking e.g. qPCR.
Time Frame
Up to 1 year
Title
Specific cytolytic activity of HA-1 T cell receptor (TCR) CD8+ and CD4+ T cells against HLA-A*0201+ HA-1+ target cells before adoptive T cell transfer
Description
Assessed by in vitro chromium release assay or equivalent cytotoxicity assay.
Time Frame
At the time of T cell infusion (at day 0)
Title
Specific cytolytic activity of HA-1 T cell receptor (TCR) CD8+ and CD4+ T cells against HLA-A*0201+ HA-1+ target cells after adoptive T cell transfer
Description
By in vitro chromium release assay or flow cytometric degranulation assay (CD107a) using samples of peripheral blood and/or bone marrow collected from patients after adoptive T cell transfer.
Time Frame
Up to 1 year
Title
Reduction of leukemia in the bone marrow in patients who have measurable leukemia in the marrow prior to HA-1 T cell receptor (TCR) T cell infusion
Description
Quantified by flow cytometry to determine percentage of leukemic cells in the marrow.
Time Frame
Up to 1 year
Title
Reduction of recipient normal hematopoietic cells in the bone marrow in patients who have measurable recipient normal hematopoietic cells in the marrow prior to HA-1 T cell receptor (TCR) T cell infusion
Description
Quantified by variable number tandem repeat (VNTR) to determine percentage of normal recipient and donor cells in the marrow.
Time Frame
Up to 1 year
Title
Proportion of patients who develop new or recurrent symptoms or signs of graft-versus-host disease
Description
Assessed using clinical evaluation and standard clinical graft versus host disease (GVHD) grading criteria
Time Frame
Up to 1 year

10. Eligibility

Sex
All
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient age 0-75 years at the time of enrollment. Patients must express HLA-A*0201 Patients must have the HA-1(H) genotype (RS_1801284: A/G, A/A) Patients must have an adult donor for HCT who is adequately HLA matched by institutional standards (includes HLA-matched related or unrelated donors, and HLA-mismatched family donors, including haploidentical donors) and is either: HLA-A*0201 positive and HA-1(H) negative (RS_1801284: G/G) or HLA-A*0201 negative Patients who are currently undergoing or who previously underwent allogeneic HCT for Acute myeloid leukemia (AML) of any subtype Acute lymphoid leukemia (ALL) of any subtype Mixed phenotype/undifferentiated/any other type of acute leukemia, including blastic plasmacytoid dendritic cell neoplasm Chronic myeloid leukemia with a history of blast crisis and: With relapse or refractory disease (>= 5% marrow blasts, or circulating blasts) at any time after HCT With persistent rising minimal residual disease (defined as detectable disease by morphology, flow cytometry, molecular or cytogenetic testing but < 5% marrow blasts by morphology, no circulating blasts on >= 2 of two consecutive tests), refractory or ineligible for treatment with tyrosine kinase inhibitors at any time after HCT Myelodysplastic syndrome (MDS) of any subtype Chronic myelomonocytic leukemia (CMML) Juvenile myelomonocytic leukemia (JMML) Patients must be able to understand and be willing to give informed consent; decision-impaired adults may consent with their legally authorized representative; parent or legal representative will be asked to consent for patients younger than 18 years old Patients must agree to participate in long-term follow-up for up to 15 years if they are enrolled in the study and receive T cell infusion Patients who have relapsed or have MRD after HCT may receive other agents for treatment of disease and remain eligible for the protocol A specific performance status score is not required for enrolling on the protocol; a delay in infusion of the HA-1 TCR T cells may be required for patients with low performance status DONOR SELECTION INCLUSION Donor age >= 18 years Donors must be able to give informed consent Patients must have an adult donor for HCT who is adequately HLA matched by institutional standards (includes HLA-matched related or unrelated donors, and HLA-mismatched family donors, including haploidentical donors) and is either: HLA-A*0201 positive and HA-1(H) negative (RS_1801284: G/G) or HLA-A*0201 negative Exclusion Criteria: Medical or psychological conditions that would make the patient unsuitable candidate for cell therapy at the discretion of the principal investigator (PI) Fertile patients unwilling to use contraception during and for 12 months after treatment Patients with a life expectancy < 3 months of enrollment from coexisting disease other than leukemia Patients who develop grade IV acute GVHD or severe chronic GVHD following most recent transplant prior to enrollment on the protocol The presence of organ toxicities will not necessarily exclude patients from enrolling on the protocol at the discretion of the PI; however, a delay in the infusion of HA-1 TCR T cells may be required DONOR SELECTION EXCLUSION Donors who are HIV-1, HIV-2, human T-lymphotropic virus (HTLV)-1, HTLV-2 seropositive or with active hepatitis B or hepatitis C virus infection Unrelated donor residing outside of the United States of America (USA) unless the donor screening, testing and leukapheresis occur at an NMDP-affiliated and qualified donor center and are facilitated by the NMDP.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth Krakow
Organizational Affiliation
Fred Hutch/University of Washington Cancer Consortium
Official's Role
Principal Investigator
Facility Information:
Facility Name
Fred Hutch/University of Washington Cancer Consortium
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

HA-1 T TCR T Cell Immunotherapy for the Treatment of Patients With Relapsed or Refractory Acute Leukemia After Donor Stem Cell Transplant

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